脊柱手术后发生肺部并发症风险评估表的临床应用  

Clinical application of risk assessment table for pulmonary complications after spine surgery

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作  者:张华星[1] 杜梦颖[2] 陈佳[3] ZHANG Huaxing;DU Mengying;CHEN Jia(Department of Medical Service,Hebei General Hospital,Shijiazhuang,Hebei 050051,China;Quality Control Office,Hebei General Hospital,Shijiazhuang,Hebei 050051,China;Department of Orthopedics,Hebei General Hospital,Shijiazhuang,Hebei 050051,China)

机构地区:[1]河北省人民医院医务处,河北石家庄050051 [2]河北省人民医院质控办,河北石家庄050051 [3]河北省人民医院骨科,河北石家庄050051

出  处:《现代医药卫生》2023年第22期3817-3820,3824,共5页Journal of Modern Medicine & Health

基  金:河北省卫生健康委员会医学科学研究课题(20200766)。

摘  要:目的探讨临床应用脊柱手术后发生肺部并发症风险评估表进行预测和管理,并验证其有效性。方法对2020年6-12月在该院接受脊柱手术的患者进行前瞻性研究,使用肺部并发症风险评估表对其进行评估计分。应用受试者特征曲线(ROC曲线)下面积(AUC)评价预测模型的效果。结合灵敏度和特异度,选择二者之和最大的截断点作为界值,确定识别高危患者人群的标准。结果388例患者纳入该研究,28例患者(7.22%)术后发生肺部并发症,其中肺部炎症19例,胸腔积液6例,呼吸衰竭3例。术前评估得分的ROC曲线下AUC为0.855,显示评估具有较高的准确性;术后评估得分的ROC曲线下AUC为0.759,出院前ROC曲线下AUC为0.769,显示评估结果可靠。综合灵敏度和特异度,结果显示术前评估总得分超过6.5分、术后评估总得分超过15.5分、出院前评估总得分超过15.5分的脊柱手术患者术后发生肺部并发症的风险较高。结论该风险评估表的效果可靠,为临床上客观量化患者脊柱手术后发生肺部并发症的危险程度提供了有效的参考依据。Objective To explore the clinical application of the risk assessment table forpredicting and managing pulmonary complications after spinal surgery,and to verify its effectiveness.Methods A prospective study was conducted on patients who underwent spinal surgery in this hospital from June to December 2020,and the risk assessment table was used to evaluate and score them.The area under receiver characteristic curve(ROC curve)(AUC)was used to evaluate the effect of the prediction model combining sensitivity and specificity,the cutoff point with the largest sum of the two was selected as the boundary value to determine the criteria for identifying highrisk patients.Results A total of 388 patients were included in the study,of which 28 patients(7.22%)had postoperative pulmonary complications,including 19 cases of pulmonary inflammation,six cases of pleural effusion and three cases of respiratory failure.The AUC under the ROC curve of preoperative evaluation score was 0.855,which showed that the evaluation had high accuracy.The AUC under the ROC curve of the postoperative evaluation score was 0.759,and that pre-discharge was 0.769,indicating that the evaluation result was reliable.According to the comprehensive sensitivity and specificity,the results showed that the spinal surgery patients with a total score of preoperative evaluation was more than 6.5 points,the total score of postoperative evaluation was more than 15.5 points,and the total score of more than 15.5 in the pre-discharge assessment had a higher risk of postoperative pulmonary complications.Conclusion The clinical effect of the risk assessment table is reliable,which provides an effective reference for objectively quantifying the risk of pulmonary complications after spinal surgery.

关 键 词:脊柱手术 肺部并发症 风险评估表 手术后 临床应用 

分 类 号:R681.5[医药卫生—骨科学] R683.2[医药卫生—外科学]

 

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