解剖性肺切除术后持续漏气预测模型构建

发布时间：2019-02-08 20:37

【摘要】：背景与目的解剖性肺切除术后持续漏气(prolonged air leak,PAL)是胸外科常见并发症,重在准确预测及时预防,但目前国内尚缺少有效的预测模型,本研究旨在建立解剖性肺切除术后PAL临床预测模型。方法回顾分析2016年1月-2016年10月安徽医科大学附属省立医院胸外科解剖性肺切除术患者的临床资料和术后漏气情况,其中A组病例359例,通过对患者的年龄(岁)、性别、身体质量指数(body mass index,BMI)、吸烟史、肺功能指数、手术方式(开放或腔镜,肺段、肺叶或其他,如支气管袖式或血管袖式)、手术切除肺叶位置、肺部病灶性质和胸腔粘连情况进行单因素及多因素分析,寻找解剖性肺切除术后PAL的独立预测因子,并建立临床预测模型。随后利用不同时期、不同治疗组完成的112例解剖肺切除患者作为B组,用于验证本模型的诊断效能,并绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线。结果多因素Logistic回归分析筛选出BMI、性别、吸烟史、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%)、胸腔粘连及是否上叶切除为解剖性肺切除患者术后PAL的独立预测因子。利用筛选出的预测因子建立的诊断模型ROC曲线下面积为0.886(95%CI:0.835-0.937),最佳临界值P=0.299,对应的诊断敏感性为78.5%,特异性为93.2%。结论本研究建立的预测模型能较准确的预测解剖性肺切除术后PAL的发生,对及时有效预防PAL发生有指导作用。
[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.
【作者单位】：中国科学技术大学附属第一医院(安徽省立医院)胸外科;
【分类号】：R655.3

【相似文献】