目的 在规范肺康复管理路径实施背景下，分析胸腔镜下袖式肺叶切除术后患者肺部并发症（postoperative pulmonary complications，PPCs）的相关危险因素，为实施精准风险分层护理提供依据。 方法 回顾性收集2018年12月—2026年4月于杭州市某三级甲等医院胸外科行胸腔镜下袖式肺叶切除术的肺癌患者的临床资料。所有患者均按照统一规范进行围手术期肺康复路径管理。根据术后是否发生PPCs分组，采用单因素分析筛选相关变量，并纳入多因素Logistic回归分析明确独立影响因素，构建可预测肺癌患者袖式肺叶切除术后PPCs的风险预测模型，并通过绘制受试者工作特征曲线评估该模型的预测效能和准确度。 结果 共纳入124例患者，其中26例（20.97%）发生PPCs。多因素Logistic回归分析显示，年龄（OR=5.03，95%CI：1.15~22.02，P=0.03），合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）（OR=3.70，95%CI 1.07~12.76，P=0.04），手术时长（OR=1.02，95%CI：1.01~1.03，P<0.01）和术中失血量（OR=1.01，95%CI：1.00~1.02，P<0.01）是PPCs的独立危险因素，而第1秒用力呼气容积（forced expiratory volume in 1 second，FEV1）（OR=0.21，95%CI：0.05~0.80，P=0.02）是独立保护因素，且年龄≥65岁、合并COPD、FEV1<2.38 L、手术时长≥172.50 min，术中失血量≥135.00 mL的患者PPCs风险较高。 结论 在规范肺康复管理背景下，袖式肺叶切除术后仍存在一定比例的PPCs。PPCs的发生是一个多因素共同作用的结果，基于各项影响因素实施精准分层肺康复管理，有望有效降低PPCs发生率，改善患者预后。

Objective To analyze the risk factors for postoperative pulmonary complications（PPCs） following thoracoscopic sleeve lobectomy with standardized pulmonary rehabilitation management，and to provide a basis for precise risk-stratified nursing care. Methods Clinical data of lung cancer patients who underwent thoracoscopic sleeve lobectomy in the Department of Thoracic Surgery of a general class A hospital from December 2018 to April 2026 were retrospectively collected. All patients received standardized pulmonary rehabilitation management. Patients were divided into two groups based on the occurrence of PPCs. Univariable analysis was performed to screen relevant variables，followed by multivariable logistic regression analysis to identify independent risk factors. A predictive model for PPCs after sleeve lobectomy was established based on the multivariable regression results，and its predictive performance and accuracy were evaluated using receiver operating characteristic（ROC） curves. Results A total of 124 patients were included，and 26（20.97%） of them developed PPCs. Multivariate logistic regression analysis revealed that age（OR=5.03，95%CI：1.15~22.02，P=0.03），comorbid COPD（OR=3.70，95%CI：1.07~12.76，P=0.04），operative time（OR=1.02，95%CI：1.01~1.03，P<0.01），and intraoperative blood loss（OR=1.01，95%CI：1.00~1.02，P<0.01） were independent risk factors for PPCs，whereas FEV1（OR=0.21，95%CI：0.05~0.80，P=0.02） was an independent protective factor. Patients aged ≥65 years，with comorbid COPD，FEV1<2.38 L，operative time ≥172.50 min，or intraoperative blood loss ≥135.00 ml had a higher risk of PPCs. Conclusion Under standardized pulmonary rehabilitation management，there remains a considerable proportion of PPCs after sleeve lobectomy. The occurrence of PPCs is the result of multiple interacting factors. Implementing precise，stratified pulmonary rehabilitation management based on these influencing factors may effectively reduce the incidence of PPCs and improve patient outcomes.