解剖性肺切除術(shù)后持續(xù)漏氣預(yù)測模型構(gòu)建
發(fā)布時間：2019-02-08 20:37
【摘要】：背景與目的解剖性肺切除術(shù)后持續(xù)漏氣(prolonged air leak,PAL)是胸外科常見并發(fā)癥,重在準(zhǔn)確預(yù)測及時預(yù)防,但目前國內(nèi)尚缺少有效的預(yù)測模型,本研究旨在建立解剖性肺切除術(shù)后PAL臨床預(yù)測模型。方法回顧分析2016年1月-2016年10月安徽醫(yī)科大學(xué)附屬省立醫(yī)院胸外科解剖性肺切除術(shù)患者的臨床資料和術(shù)后漏氣情況,其中A組病例359例,通過對患者的年齡(歲)、性別、身體質(zhì)量指數(shù)(body mass index,BMI)、吸煙史、肺功能指數(shù)、手術(shù)方式(開放或腔鏡,肺段、肺葉或其他,如支氣管袖式或血管袖式)、手術(shù)切除肺葉位置、肺部病灶性質(zhì)和胸腔粘連情況進(jìn)行單因素及多因素分析,尋找解剖性肺切除術(shù)后PAL的獨(dú)立預(yù)測因子,并建立臨床預(yù)測模型。隨后利用不同時期、不同治療組完成的112例解剖肺切除患者作為B組,用于驗(yàn)證本模型的診斷效能,并繪制受試者工作特征(receiver operating characteristic curve,ROC)曲線。結(jié)果多因素Logistic回歸分析篩選出BMI、性別、吸煙史、第一秒用力肺活量占用力肺活量的百分比(forced expiratory volume in one second,FEV1%)、胸腔粘連及是否上葉切除為解剖性肺切除患者術(shù)后PAL的獨(dú)立預(yù)測因子。利用篩選出的預(yù)測因子建立的診斷模型ROC曲線下面積為0.886(95%CI:0.835-0.937),最佳臨界值P=0.299,對應(yīng)的診斷敏感性為78.5%,特異性為93.2%。結(jié)論本研究建立的預(yù)測模型能較準(zhǔn)確的預(yù)測解剖性肺切除術(shù)后PAL的發(fā)生,對及時有效預(yù)防PAL發(fā)生有指導(dǎo)作用。
[Abstract]:Background and objective (prolonged air leak,PAL is a common complication in thoracic surgery. It is important to accurately predict and prevent it in time. However, there is still a lack of effective prediction model in China. The purpose of this study was to establish a clinical prediction model of PAL after anatomic pneumonectomy. Methods from January 2016 to October 2016, the clinical data and postoperative air leakage in thoracic surgical dissecting pneumonectomy in the provincial hospital affiliated to Anhui Medical University were retrospectively analyzed. 359 cases in group A were treated by age (age) and sex. Body mass index (body mass index,BMI), smoking history, pulmonary function index, surgical procedure (open or endoscopic, lung segment, lobes or other, such as bronchial sleeve or vascular sleeve), surgical resection of lobar position, Univariate and multivariate analysis was carried out to find the independent predictor of PAL after dissecting pneumonectomy and to establish a clinical predictive model. Then 112 patients with dissected pneumonectomy in different treatment groups were used as group B to verify the diagnostic efficacy of the model and to draw the (receiver operating characteristic curve,ROC curves of the subjects' operating characteristics. Results multiple factor Logistic regression analysis showed that the sex of BMI, smoking history, percentage of vital capacity occupied by forced vital capacity in the first second (forced expiratory volume in one second,FEV1%), Thoracic adhesion and upper lobectomy were independent predictors of PAL in patients with anatomical pneumonectomy. The area under the ROC curve was 0.886 (95%CI:0.835-0.937) and the optimal critical value was 0.299. The diagnostic sensitivity was 78.5 and the specificity was 93.2%. Conclusion the prediction model established in this study can accurately predict the occurrence of PAL after dissecting pneumonectomy, and can be used as a guide to prevent the occurrence of PAL in a timely and effective manner.
【作者單位】： 中國科學(xué)技術(shù)大學(xué)附屬第一醫(yī)院(安徽省立醫(yī)院)胸外科;
【分類號】：R655.3
[Abstract]:Background and objective (prolonged air leak,PAL is a common complication in thoracic surgery. It is important to accurately predict and prevent it in time. However, there is still a lack of effective prediction model in China. The purpose of this study was to establish a clinical prediction model of PAL after anatomic pneumonectomy. Methods from January 2016 to October 2016, the clinical data and postoperative air leakage in thoracic surgical dissecting pneumonectomy in the provincial hospital affiliated to Anhui Medical University were retrospectively analyzed. 359 cases in group A were treated by age (age) and sex. Body mass index (body mass index,BMI), smoking history, pulmonary function index, surgical procedure (open or endoscopic, lung segment, lobes or other, such as bronchial sleeve or vascular sleeve), surgical resection of lobar position, Univariate and multivariate analysis was carried out to find the independent predictor of PAL after dissecting pneumonectomy and to establish a clinical predictive model. Then 112 patients with dissected pneumonectomy in different treatment groups were used as group B to verify the diagnostic efficacy of the model and to draw the (receiver operating characteristic curve,ROC curves of the subjects' operating characteristics. Results multiple factor Logistic regression analysis showed that the sex of BMI, smoking history, percentage of vital capacity occupied by forced vital capacity in the first second (forced expiratory volume in one second,FEV1%), Thoracic adhesion and upper lobectomy were independent predictors of PAL in patients with anatomical pneumonectomy. The area under the ROC curve was 0.886 (95%CI:0.835-0.937) and the optimal critical value was 0.299. The diagnostic sensitivity was 78.5 and the specificity was 93.2%. Conclusion the prediction model established in this study can accurately predict the occurrence of PAL after dissecting pneumonectomy, and can be used as a guide to prevent the occurrence of PAL in a timely and effective manner.
【作者單位】： 中國科學(xué)技術(shù)大學(xué)附屬第一醫(yī)院(安徽省立醫(yī)院)胸外科;
【分類號】：R655.3
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