公式计算的心肺适能(CRF)和6分钟步行距离(6MWD)预测上腹部大手术术后肺部并发症(PPCs)的效能比较

Comparison of algorithm-derived cardiorespiratory fitness(CRF)and 6 minutes walking distance(6MWD)in predicting postoperative pulmonary complications(PPCs)in patients undergoing major upper abdominal surgery

目的比较6分钟步行距离(6 minute walking distance,6MWD)和公式计算的心肺适能(cardiorespiratory fitness,CRF)对上腹部大手术术后肺部并发症(postoperative pulmonary complications,PPCs)的预测效能。方法连续纳入2018年8月至2019年7月择期行上腹部大手术的患者。所有患者术前均行6MWD,记录相关临床资料。根据6MWD、年龄、性别、体重和静息心率计算CRF。根据是否发生有临床意义的PPCs,将患者分为PPCs组和非PPCs组。采用多因素Logistic回归分析PPCs的独立危险因素,分析6MWD和CRF预测PPCs的敏感性、特异性和最佳临界值,采用Z检验比较6MWD和CRF预测PPCs的ROC曲线下面积(AUC)。结果共纳入161例患者,其中35例患者发生有临床意义的PPCs,发生率为21.7%。PPCs组的6MWD为(346.7±109.0)m,显著小于非PPCs组的(439.9±68.3)m(P<0.001)。PPCs组的CRF为(8.0±1.3)MET,显著低于非PPCs组的(10.1±1.2)MET(P<0.001)。多因素Logistic回归分析显示6MWD、年龄、静息心率和体重指数(body mass index,BMI)是PPCs的独立危险因素。6MWD预测PPCs的最佳临界值为389 m,敏感度为68.6%,特异度为81.0%。公式计算的CRF预测PPCs的最佳临界值为9.27 MET,敏感度为91.4%,特异度为76.2%。公式计算的CRF预测PPCs的AUC显著大于6MWD的AUC(Z=2.624,P=0.009)。结论公式计算的CRF预测上腹部大手术患者PPCs的效能显著优于单纯6MWD,公式计算的CRF可作为筛查上腹部大手术PPCs高危患者的有效方法。

Objectives To compare the predicting performance on postoperative pulmonary complications(PPCs)between 6-minute walking distance(6 MWD)and algorithm-derived cardiorespiratory fitness(CRF)in patients undergoing major upper abdominal surgery.Methods Patients scheduled for major upper abdominal surgery from Aug 2018 to Jul 2019 were consecutively enrolled.6 MWD was performed and clinical characteristics were recorded before surgery.CRF was estimated using a formula consisting of 6 MWD,age,body weight,and resting heart rate.The occurrence of PPCs after surgery was recorded.Patents were divided into PPCs group and non-PPCs group according to whether clinically significant PPCs occurred.The independent risk factors of PPCs were analyzed using multiple Logistic regression.The sensitivity,specificity and cut-off point of 6 MWD and algorithm-derived CRF to predict PPCs were analyzed.Area under receiver operating characteristic curve(AUC)between6 MWD and algorithm-derived CRF was compared using Z test.Results One hundred and sixty one patients undergoing major upper abdominal surgery were enrolled.PPCs occurred in 35 patients(21.7%).6 MWD in PPCs patients was(346.7±109.0)m,which was significantly lower than that in non-PPCs patients of(439.9±68.3)m(P<0.001).CRF in PPCs group was(8.0±1.3)MET,which was significantly lower than that in non-PPCs group of(10.1±1.2)MET(P<0.001).Multivariate logistic regression analysis showed that 6 MWD,age,resting heart rate and body mass index(BMI)were independent risk factors for PPCs.6 MWD≤389 m was cut-off point for predicting PPCs with sensitivity of68.6%and specificity of 81.0%.CRF≤9.27 MET was cut-off point for predicting PPCs with sensitivity of91.4%and specificity of 76.2%.The AUC of CRF to predict PPCs was significantly bigger than that of6 MWD(Z=2.624,P=0.009).Conclusion Algorithm-derived CRF is better than 6 MWD alone in predicting PPCs in patients undergoing major upper abdominal surgery.Algorithm-derived CRF is an effective tool to screen patients with high risk for PPCs after major upper abdominal surgery.