老年胃癌患者术后死亡危险因素分析  

Risk factors of postoperative death in elder patients with gastric cancer

作　　者：张宇[1] 张琪[1] 叶晓峥[1] 魏星[1] 裘华森[1] 

机构地区：[1]浙江中医药大学附属第一医院胃肠外科,杭州310006

出　　处：《浙江医学》2013年第9期744-746,共3页Zhejiang Medical Journal

基　　金：十一五国家科技支撑计划(2008BAI53B032)

摘　　要：目的探讨老年患者胃癌切除术后死亡的主要危险因索,建立Logistic预测模型。方法选取236例老年胃癌切除患者,比较术后死亡患者与生存患者的临床资料,将有统计学意义的单因素作为自变量进行多因素Logistic回归分析,建立回归方程获取预测模型,评价其预测术后死亡的灵敏度、特异度、准确度。结果本组患者术后病死率为8.9%。具有统计学意义的9个单因素[年龄、术前血红蛋白水平、血清白蛋白水平、手术时间、术中输液量、肿瘤长径、肿瘤分化程度、合并疾病(心血管疾病、慢性阻塞性肺病)]行Logistic回归分析,结果显示老年胃癌患者术后死亡与慢性阻塞性肺疾病和年龄有关,获得预测模型为:P=1/[1+e^((24.8795-0.3198X1-21803X9))],此模型预测胃癌术后死亡的准确度为95.3%,灵敏度为100%,特异度为47.6%。结论慢性阻塞性肺疾病及年龄是老年胃癌患者术后死亡的独立危险因素。Objective To assess the risk factors of postoperative death in elder patients with gastric cancer. Methods The clinical data of 236 elder patients with gastric cancer undergoing gastrectomy were retrospectively analyzed. Univariate analysis was performed with 56 clinical variables first, then, multivariate logistic regression analysis was used for selected vari- ables and the logistic regression model was established. The accuracy, sensitivity and specificity of the logistic model to predi- cate the probability of postoperative death were assessed. Results The postoperative mortality in this group of patients was 8.9%. Nine clinical variables, including chronic obstructive pulmonary disease（COPD）, cardiac diseases, procedure duration, size of tumor long diameter, volume of fluid infusion, differentiation grade of tumor, serum level of hemoglobin, serum level of albumin and age entered the multivariate analysis. Logistic regression analysis revealed that COPD and age were significantly associated with postoperative death in elder patients. And a logistic regression equation to predict postoperative death was established P=1/[1＋e（24.8795-0.3198×2.1803×9）]. The accuracy, sensitivity and specificity of the logistic model were 95.3%, 100% and 47.6% respectively. Conclusion COPD and age are the independent risk factors of postoperative death for elder patients with gastric cancer.

关 键 词：胃肿瘤 病死率 手术并发症 回归分析 老年人 

分 类 号：R735.2[医药卫生—肿瘤]