Goddard评分在评估COPD肺癌患者胸腔镜术后并发症的应用

Application of Goddard score in evaluating postoperative complications of thoracoscopy in patients with chronic obstructive pulmonary disease complicated by lung cancer

目的探讨基于胸部CT的肺气肿Goddard评分在评估COPD肺癌患者胸腔镜术后肺部并发症中的应用价值及其预测能力。方法回顾性收集符合纳入标准的合并COPD的肺癌患者,行胸腔镜肺叶切除术或楔形切除术,并于手术前1个月内行胸部CT及临床肺功能检查。分析患者术前COPD分级、Goddard评分与术后肺部并发症之间的关系。应用ROC曲线评价Goddard评分对术后肺部并发症的预测能力。结果共有85例COPD肺癌患者纳入研究。其中25例(29.41%)患者出现术后肺部并发症,依次为肺部感染、肺不张和呼吸衰竭。术后肺部并发症发生率:COPD 2级11/25(44%)高于1级8/51(15.69%),3级6/9(66.67%)高于1级,而2级与3级差异无统计学意义(P>0.05)。随着COPD级别增加,Goddard评分依次增加,差异有统计学意义(P<0.05)。有术后肺部并发症患者的Goddard评分明显高于无并发症者(P<0.05)。Goddard评分预测术后肺部并发症发生的ROC曲线下面积为0.830,最佳临界值为5.50,敏感度和特异度为96.0%和38.3%。结论术前胸部CT Goddard评分可以较好地评估和预测胸腔镜术后肺部并发症的发生,对临床治疗具有一定指导意义。

Objective To investigate the application value and predictive efficiency of Goddard score in evaluating postoperative complications of thoracoscopy in patients with chronic obstructive pulmonary disease(COPD)complicated by lung cancer.Methods The COPD patients with lung cancer who met the inclusion criteria were collected in the retrospective study,who underwent thoracoscopic lobectomy or wedge resection,moreover,chest CT and clinical pulmonary function examination were performed within one month before surgery.The corrrelation between preoperative COPD grading,Goddard score and postoperative pulmonary complications was analyzed.And the ROC curve was used to evaluate the predictive efficiency of Goddard score in evaluating postoperative complications of thoracoscopy in COPD patients with lung cancer.Results A total of 85 COPD patients with lung cancer were enrolled in the study,of whom,25 patients(29.41%)had at least one pulmonary complication after operation.The most common complications were pulmonary infection,atelectasis and respiratory failure.The incidence rate of postoperative pulmonary complications in COPD grade 2(11/25,44%)was higher than that in grade 1(8/51,15.69%),which in grade 3(6/9,66.67%)was higher than that in grade 1,however,there was no significant difference between grade 2 and grade 3.With the increase of COPD grade,the Goddard scores were increased in turn,and the difference was statistically significant(P<0.05).The Goddard scores(7.96±2.39)in patients with postoperative pulmonary complications were significantly higher than those(4.57±2.69)of patients without postoperative pulmonary complications(P<0.05).The area under the ROC curve of Goddard score in predicting the postoperative pulmonary complications was 0.830,and an optimal cut-off value was 5.50,with a sensitivity and specificity being 96.0%,38.3%,respectively.Conclusion Goddard score and chest CT before operation can better evaluate and predict the occurrence of pulmonary complications after thoracoscopic surgery,which has certain guiding significance for clinical treatment.