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  

High risk factors and prediction model construction of cardiopulmonary complications in patients with abnormal lung function after pulmonary resection

作　　者：郭军号 金刚 赵智 南方圆 胡允胜 胡蕖 Guo Junhao;Jin Gang;Zhao Zhi;Nan Fangyuan;Hu Yunsheng;Hu Qu(Department of Thoracic Surgery,First People's Hospital of Jiangxia District,Wuhan 430200,China;Surgery Department of Traditional Chinese Medicine Hospital,Jiangxia District,Wuhan 430200,China)

机构地区：[1]武汉市江夏区第一人民医院胸外科,武汉430200 [2]武汉市江夏区中医医院外科,武汉430200

出　　处：《首都医科大学学报》2023年第6期1081-1086,共6页Journal of Capital Medical University

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。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 hei

关 键 词：肺功能异常 肺切除术 并发症 模型 

分 类 号：R655[医药卫生—外科学]