CO_2吸收量表预测胸腹腔镜联合食管癌根治术后CO_2蓄积并发症的价值  

Value of CO_2 absorption scores applied in predicting complications induced by CO_2 in combined thoracoscopic and laparoscopic esophagectomy

作　　者：段文明[1] 汪洋[2] 于婵娟[1] DUAN Wenming;WANG Yang;YU Chanjuan(Department of Anesthesiology,Affiliated Tumor Hospital, Xinjiang Medical University,Urumqi 830011,China;Department of Thoracic Surgery,Affiliated Tumor Hospital, Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院麻醉科,乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院胸外科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2018年第2期184-188,共5页Journal of Xinjiang Medical University

基　　金：新疆医科大学科研创新基金(XYDCX2014108)

摘　　要：目的开发应用预测胸腹腔镜联合食管癌根治术后CO_2蓄积并发症的评分量表,并评估其预测价值。方法回顾性收集410例行胸腹腔镜联合食管癌根治术患者(推衍队列)的临床和病理资料,通过单因素和多因素分析(二项分类Logistic回归模型)鉴定其发生CO_2蓄积并发症的独立预测因子,根据调整OR值对独立预测因子进行赋分,建立CO_2吸收评分量表,并通过接收者工作特征曲线评估该评分量表预测另外120例行胸腹腔镜联合食管癌根治术患者(验证队列)CO_2蓄积并发症发生情况的价值。结果推衍队列的多因素分析结果显示,术前1s用力呼气容积(FEV1)/用力肺活量(FVC)<70%、左心室射血分数(LVEF)≤50%、肿瘤TNM分期为Ⅲ、Ⅳ期、肿瘤位于食管中、下段及发生淋巴结转移是CO_2蓄积并发症的独立预测因子,以独立预测因子的调整OR值为1.5~2.0时赋分为1、为2.0~3.0时赋分为2,建立分值范围为0~10的评分量表,分值越高代表术后发生CO_2蓄积并发症的风险越高;ROC分析结果显示该量表预测推衍队列和验证队列CO_2蓄积并发症的曲线下面积分别为0.923(标准误:0.013,95%CI:0.897-0.949,P<0.001)和0.915(标准误:0.027,95%CI:0.862-0.969,P<0.001),且二者曲线下面积之间差异无统计学意义(Z=0.267,P=0.395)。结论 CO_2吸收量表能有效预测胸腹腔镜联合食管癌根治术后CO_2蓄积并发症发生的风险,为减少术后CO_2蓄积并发症提供依据。ObjectiveTo develop a CO2 absorption score applied in predicting complications induced by CO2 in combined thoracoscopic and laparoscopic esophagectomy and evaluate its value.MethodsA total of 410 patients(derivation cohort)undergoing combined thoracoscopic and laparoscopic esophagectomy were retrospectively analyzed,and independent predictors were identified with univariate and multivariate analysis.Specific scores were assigned to independent predictors according to their ORs to establish a CO2 absorption score.Finally,the CO2 absorption score was verified in a validation cohort including 120 patients undergoing combined thoracoscopic and laparoscopic esophagectomy with Receiver Operating Characteristics(ROC)curve.ResultsMultivariate analysis of derivation cohort showed that preoperative forced expiratory volume in one second(FEV1)/forced vital capacity(FVC)<70%,left ventricular ejection fraction(LVEF)≤50%,TNM stages ofⅢandⅣ,locusinferior tumor or middle esophageal tumor and lymphatic metastasis were independent predictors for complications induced by CO2.Adjusted ORs of 1.5-2.0 were assigned to 1 score,and 2.0-3.0 were assigned to 2 scores.A CO2 absorption score was established ranging 0-10 scores.Higher scores implied higher risk for complications induced by CO2.According to ROC analysis,the area under ROC curve was 0.923 and 0.915,respectively for derivation cohort(Standard error:0.013,95%CI:0.897-0.949,P<0.001)and validation cohort(Standard error:0.027,95%CI:0.862-0.969,P<0.001),and their areas were not statistically different(Z=0.267,P=0.395).ConclusionThe CO2 absorption score was able to effectively predict the risk for complications induced by CO2 in combined thoracoscopic and laparoscopic esophagectomy,and might provide useful information for reducing incidence of complications induced by CO2.

关 键 词：胸腹腔镜联合食管癌根治术 CO2吸收量表 价值 

分 类 号：R735.1[医药卫生—肿瘤]