肺功能异常患者肺切除术后心肺并发症发生的高危因素及预测模型构建

doi:10.3969/j.issn.1006-7795.2023.06.026

摘要/Abstract

摘要： 目的探讨存在肺功能异常的患者肺切除术后心肺并发症发生的高危因素并构建预测模型，为早期识别高危人群及制定干预方案提供更多参考。方法纳入2015年1月至2022年6月于武汉市江夏区第一人民医院行肺切除术治疗且存在肺功能异常的375例患者，根据术后是否出现心肺并发症分为并发症组（70例)和非并发症组（305例)；比较两组患者的基线临床特征资料，采用Logistic回归模型评价肺切除术后心肺并发症发生的独立危险因素；构建肺切除术后心肺并发症发生的预测模型并进行预测效能分析。结果 375例患者术后出现心肺并发症者70例，发生率为18.67%。两组患者的一秒用力呼气容积占预计值百分比、肺一氧化碳弥散量占预计值百分比、登楼高度、登楼试验前后心率差值及动脉血氧饱和度差值比较，差异均有统计学意义（P<0.05)。多因素分析结果显示，登楼高度、登楼试验前后心率差值及动脉血氧饱和度差值是肺切除术后心肺并发症发生的独立危险因素（P<0.05)。利用Logistic回归对于肺切除术后心肺并发症发生的情况进行预测，最佳截断值为70.07%，约登指数为54.15%。结论存在肺功能异常的患者肺切除术后心肺并发症的发生与登楼高度、登楼试验前后心率差值及动脉血氧饱和度差值的关系密切；基于以上因素构建的模型可准确预测术后心肺并发症的发生风险。

关键词: 肺功能异常, 肺切除术, 并发症, 模型

Abstract: Objective To investigate the high risk factors and construct prediction model of cardiopulmonary complications in patients with abnormal lung function after pulmonary resection to provide more reference for follow-up clinical diagnosis and treatment. Methods A total of 375 patients with abnormal pulmonary function who underwent pneumonectomy in our hospital from January 2015 to June 2022 were retrospectively enrolled. They were divided into complication group (70 cases) and non complication group (305 cases) according to whether cardiopulmonary complications occurred after surgery. The baseline clinical characteristics of the two groups were compared, and the independent risk factors of cardiopulmonary complications after pneumonectomy were evaluated by Logistic regression model. The predictive model for cardiopulmonary complications after pneumonectomy was developed and predictive efficacy was analyzed. Results Cardiopulmonary complications occurred in 70 of the 375 patients (18.67%). There were significant differences in the the first second forced expiratory volume as a percentage of the predicted value (FEV1%pred), diffusing capacity of the lungs for carbon monoxide as a percentage of the predicted value(DLCO%pred), landing height, heart rate difference before and after stair climb test (SCT), and arterial oxygen saturation difference before and after SCT between the two groups (P<0.05). The results of multi-factor analysis showed that the height of boarding, the difference of heart rate before and after SCT, and the difference of arterial oxygen saturation before and after SCT were independent risk factors for the occurrence of cardiopulmonary complications after pulmonary resection (P<0.05). The Logistic prediction probability was used to predict the occurrence of cardiopulmonary complications after pneumonectomy. The optimal cut-off value was 70.07% and the Jorden index was 54.15%. Conclusion The incidence of cardiopulmonary complications in patients with pulmonary dysfunction after pulmonary resection was closely related to the height of boarding, the difference of heart rate before and after SCT, and the difference of arterial oxygen saturation before and after SCT. The model based on the above factors can accurately predict the risk of postoperative cardiopulmonary complications.

Key words: abnormal lung function, pulmonary resection, complications, model

中图分类号:

R655

郭军号, 金刚, 赵智, 南方圆, 胡允胜, 胡蕖. 肺功能异常患者肺切除术后心肺并发症发生的高危因素及预测模型构建[J]. 首都医科大学学报, 2023, 44(6): 1081-1086.

Guo Junhao, Jin Gang, Zhao Zhi, Nan Fangyuan, Hu Yunsheng, Hu Qu. High risk factors and prediction model construction of cardiopulmonary complications in patients with abnormal lung function after pulmonary resection[J]. Journal of Capital Medical University, 2023, 44(6): 1081-1086.

参考文献

［1］Colquhoun D A, Leis A M, Shanks A M, et al. A lower tidal volume regimen during one-lung ventilation for lung resection surgery is not associated with reduced postoperative pulmonary complications［J］. Anesthesiology, 2021, 134(4): 562-576.
［2］中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南-肺弥散功能检查［J］. 中华结核和呼吸杂志, 2015, 38(3): 164-169.
［3］Whittaker Brown S A, Padilla M, Mhango G, et al. Interstitial lung abnormalities and lung cancer risk in the national lung screening trial［J］. Chest, 2019, 156(6): 1195-1203.
［4］Kawaguchi T, Sawabata N, Miura S, et al. Prognostic impact of underlying lung disease in pulmonary wedge resection for lung cancer［J］. Int J Clin Oncol, 2019, 24(4): 366-374.
［5］Lee H Y, Lee J, Lee C H, et al. Risk of cancer incidence in patients with idiopathic pulmonary fibrosis: a nationwide cohort study［J］. Respirology, 2021, 26(2): 180-187.
［6］Ko H K, Liu C Y, Ho L I, et al. Predictors of delayed extubation following lung resection: focusing on preoperative pulmonary function and incentive spirometry［J］. J Chin Med Assoc, 2021, 84(4): 368-374.
［7］Kubori Y, Matsuki R, Hotta A, et al. Association between pulmonary function and stair-climbing test results after lung resection: a pilot study［J］. Can Respir J, 2018, 2018: 1925028.
［8］Suehs C M, Solovei L, Hireche K, et al. Complication and lung function impairment prediction using perfusion and computed tomography air trapping (CLIPPCAIR): protocol for the development and validation of a novel multivariable model for the prediction of post-resection lung function［J］. Ann Transl Med, 2021, 9(13): 1092.
［9］Mao X W, Zhang W, Wang Q, et al. Assessment of systemic immune-inflammation index in predicting postoperative pulmonary complications in patients undergoing lung cancer resection［J］. Surgery, 2022, 172(1): 365-370.
［10］He B M, Chen R, Gao X, et al. Nomograms for predicting Gleason upgrading in a contemporary Chinese cohort receiving radical prostatectomy after extended prostate biopsy: development and internal validation［J］. Oncotarget, 2016, 7(13): 17275-17285.
［11］Brunelli A, Kim A W, Berger K I, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines ［J］. Chest， 2013，143(5 Suppl):e166S-e190S.
［12］Boujibar F, Gillibert A, Gravier F E, et al. Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis［J］. Thorax, 2020, 75(9): 791-797.
［13］Nakamura T, Sawabata N, Susaki Y, et al. Desaturation during the stair-climbing test for patients who will undergo pulmonary resection: an indicator of postoperative complications［J］. Gen Thorac Cardiovasc Surg, 2020, 68(1): 49-56.
［14］Mao X W, Zhang W, Ni Y Q, et al. A prediction model for postoperative pulmonary complication in pulmonary function-impaired patients following lung resection［J］. J Multidiscip Healthc, 2021, 14: 3187-3194.
［15］Dong J S, Mao Y S, Li J G, et al. Stair-climbing test predicts postoperativecardiopulmonary complications and hospital stay in patients with non-small cell lung cancer［J］. Med Sci Monit, 2017, 23: 1436-1441.
［16］董静思, 毛友生, 严少平, 等. 常规肺功能检测联合登楼梯试验在预测非小细胞肺癌患者术后心肺并发症中的作用［J］. 中华肿瘤杂志, 2014, 36(1): 53-58.
［17］Godbole R, Church S B, Abolhoda A, et al. Resting physiologic dead space as predictor of postoperative pulmonary complications after robotic-assisted lung resection: a pilot study［J］. Front Physiol, 2022, 13: 803641.
［18］Novoa N M, Esteban P, Rodriguez M, et al. Functional evaluation before lung resection: searching for a low technology test in a safer environment for the patient: a pilot study［J］. Eur J Cardiothorac Surg, 2017, 51(5): 856-860.

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