肺移植围手术期预后风险因素分析及术后气管插管延迟拔管风险预测  

Risk analysis of perioperative outcomes of lung transplantation and the prediction of delayed extubation

作　　者：高培根 张磊 沈下贤 张培 戴晨阳 李玉萍[1] 何文新[1] 陈乾坤[1] 姜格宁[1] 陈昶[1] Gao Peigen;Zhang Lei;Shen Xiaxian;Zhang Pei;Dai Chenyang;Li Yuping;He Wenxin;Chen Qiankun;Jiang Gening;Chen Chang(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji university School of Medicine,Shanghai Engineering Technology Research Center of Lung Transplantation,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科、上海肺移植工程技术研究中心,上海200433

出　　处：《中华器官移植杂志》2023年第11期645-652,共8页Chinese Journal of Organ Transplantation

基　　金：上海市科学技术委员会科技创新行动计划(20DZ2253700);上海市科学技术委员会重大研发计划(22DZ2638240)。

摘　　要：目的探究影响肺移植围手术期预后的风险因素,构建肺移植手术后延迟拔管的风险预测模型。方法回顾性分析2020年1月1日至2022年12月31日在同济大学附属上海市肺科医院接受肺移植的104例受者资料。根据受者肺移植术后气管插管拔除时间,划分为正常拔管组(拔管时间≤术后72 h,77例)和延迟拔管组(拔管时间>72 h或再次插管,27例),比较两组受者的基线特征、术前原发病诊断、冷缺血时间、移植手术方式等情况,根据受者院内的病情转归分为院内死亡组(10例)和正常出院组(94例),比较两组的临床资料,找到肺移植死亡的可能风险因素,综合6个肺移植围手术期相关变量进行单因素及多因素logistic回归分析,根据多因素logistic回归模型构建延迟拔管预测Nomogram评分表。绘制受试者工作特征曲线(receiver operator characteristic curve,ROC curve)及决策曲线分析(decision curve analysis,DCA),评价模型预测延迟拔管效能及临床应用价值。结果本研究104例肺移植受者术后院内死亡率为9.6%,术后延迟气管插管拔管率为26.0%,术后延迟气管插管拔除是影响肺移植受者围手术期预后的关键风险因素(OR=2.007,95%CI:1.117~3.444,P=0.008)。针对延迟拔管预测分析,冷缺血时间具有最佳预测效能,其与所构建的风险预测模型的ROC曲线下面积(area under the curve,AUC)分别为0.75(95%CI:0.69~0.81)和0.87(95%CI:0.82~0.91)。结论手术后气管插管延迟拔除是肺移植术后早期预后不良的重要标志。本研究所构建风险预测模型,能够有效预测肺移植手术后气管插管延迟拔除,从而实现对高危受者预防性干预,提高肺移植术后早期存活率。Objective To explore the risk factors of perioperative outcomes of lung transplantation and establish a predictive model for delayed extubation after lung transplantation.Methods From January 1,2020 to December 31,2022,104 lung transplantation recipients were retrospectively collected to identify the risk factors of early post-operative outcome.According to the timing of extubation post-lung transplantation,they were assigned into two groups of normal(77 cases)and delayed(27 cases).Baseline profiles,type of primary diagnosis,cold ischemic duration and lung transplantation approach were compared between two groups.The factors with significant difference were examined by univariate and multivariate Logistic regression.Furthermore,multivariate logistic model was visualized by a nomogram.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were performed for evaluating the model's predictive performance and its value for clinical utilization.Results The postoperative mortality rate was 9.6%.Delayed extubation was a strong predictor for postoperative mortality.Cold ischemic time outperformed others variates in terms of delayed extubation prediction.AUC of cold ischemic time and multivariate logistic model was 0.75(95%CI:0.69-0.81)and 0.87(95%CI:0.82-0.91).Conclusions Delayed postoperative extubation is a key predictor of early post-lung transplantation mortality.The established predictive model may effectively identify high-risk patients for preventive intervention and survival improvement post-lung transplantation.

关 键 词：肺移植 围手术期 气管插管 预后 

分 类 号：R655.3[医药卫生—外科学]