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.