氨基末端脑钠肽对老年患者非心脏手术后肺部并发症的预测价值  

Predictive value of amino-terminal brain natriuretic peptide for postoperative pulmonary complications in elderly patients undergoing non-cardiac surgery

作　　者：朱易豪 朱涛[2] 赵怡 郝学超 张宏伟[1] 王飞 ZHU Yihao;ZHU Tao;ZHAO Yi;HAO Xuechao;ZHANG Hongwei;WANG Fei(Department of Anesthesiology,Sichuan Cancer Hospital&Institute,Sichuan Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China)

机构地区：[1]四川省肿瘤医院、电子科技大学附属肿瘤医院麻醉科,成都市610041 [2]四川大学华西医院麻醉科 [3]四川省医学科学院、四川省人民医院、电子科技大学附属四川省人民医院麻醉科

出　　处：《临床麻醉学杂志》2023年第10期1019-1025,共7页Journal of Clinical Anesthesiology

基　　金：“十三五”国家重点研发项目(2018YFC2001800)。

摘　　要：目的评估术前氨基末端脑钠肽(NT-pro BNP)对老年患者非心脏手术后肺部并发症(PPCs)的预测价值。方法前瞻性收集行非心脏手术老年患者174例,男118例,女56例,年龄≥65岁,ASAⅠ—Ⅲ级。于术前2 h测定静脉血中NT-pro BNP水平,采用全子集回归进行变量筛选,多因素Logistic回归构建模型。通过受试者工作特征曲线下(AUC)面积和决策分析曲线评价术前NT-pro BNP对PPCs的预测价值。结果有22例(12.6%)患者发生PPCs。全子集回归分析筛选出最终变量,纳入多因素Logistic回归模型中的变量为性别、ASA分级、胰腺手术、胃肠手术、泌尿手术、活动耐量、屏气试验分级、总输液量和术前NT-pro BNP。加入术前NT-pro BNP后,多因素Logistic回归模型的AUC由0.777增加至0.815(P<0.05)。决策分析曲线结果显示,在所有风险决策阈值下,加入术前NT-pro BNP后,多因素Logistic回归模型均可获得临床净获益。结论术前NT-pro BNP是老年患者非心脏手术PPCs的独立预测因子,可显著改善模型的预测性能,获得临床净获益,实现对老年患者非心脏手术PPCs的早期精准预测及风险分层。Objective To assess the predictive value of preoperative amino-terminal brain natriuretic peptide(NT-pro BNP)for postoperative pulmonary complications(PPCs)in elderly patients undergoing non-cardiac surgery.Methods Data were prospectively collected from 174 elderly patients undergoing non-cardiac surgery,118 males and 56 females,aged≥65 years,ASA physical statusⅠ-Ⅲ.NT-pro BNP levels were measured 2 hours before surgery.Full subset regression was used for variable screening,and multivariable logistic regression was used to construct the model.The predictive value of preoperative NT-pro BNP for PPCs was evaluated by area under the receiver operating characteristic curve(AUC)and decision analysis curve.Results PPCs occurred in 22 patients(12.6%).Full subset regression analyses were performed to screen the final variables,which were ultimately included in the multivariable logistic regression model as gender,ASA physical status,pancreatic surgery,gastrointestinal surgery,urological surgery,activity tolerance grade,breath-holding test classification grade,total fluid volume,preoperative NT-pro BNP.The preoperative NT-pro BNP increased the AUC of the multivariable logistic regression model from 0.777 to 0.815(P<0.05).The results of the decision analysis curves showed a net clinical benefit from the multivariable Logistic regression model after the addition of preoperative NT-pro BNP at all risk decision thresholds.Conclusion The current limited data available suggests that preoperative NT-pro BNP is an independent predictor of PPCs in elderly patients with non-cardiac surgery,which can significantly improve the predictive performance of the model and obtain a net clinical benefit,ensuring early and accurate prediction and risk stratification of non-cardiac surgery PPCs in elderly patients.

关 键 词：氨基末端脑钠肽 术后肺部并发症 老年 预测价值 

分 类 号：R614[医药卫生—麻醉学]