胸腹腔镜食管癌根治术老年患者术后肺部并发症与术前营养不良的关系

Relationship between postoperative pulmonary complications and preoperative malnutrition in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy

目的评价胸腹腔镜食管癌根治术老年患者术后肺部并发症(PPCs)与术前营养不良的关系。方法收集江南大学附属医院择期行胸腹腔镜食管癌根治术老年患者信息,记录一般临床资料、基于全球领导人营养不良倡议标准下的营养状况、泰罗尼亚外科患者呼吸风险评估(ARISCAT)评分、肿瘤病理分期和手术有关因素等;根据住院期间是否发生PPCs将患者分为2组,比较各变量间的差异,采用logistic回归分析法筛选胸腹腔镜食管癌根治术老年患者PPCs的危险因素,通过受试者工作特征(ROC)曲线评价ARISCAT评分及其联合营养不良预测PPCs发生的准确性。结果共纳入行胸腹腔镜食管癌根治术老年患者256例,PPCs发生率为23.8%。与未发生PPCs组比较,PPCs组患者FEV1/FVC、年龄、ASA分级比率、COPD比率、营养不良比率和高ARISCAT评分比率差异有统计学意义(P<0.05)。logistic回归分析结果显示:年龄增加、COPD、营养不良和高ARISCAT评分是PPCs的独立危险因素。ARISCAT评分及其联合营养不良预测PPCs发生的ROC曲线下面积分别为0.722和0.777,差异有统计学意义(P<0.05)。结论术前营养不良是胸腹腔镜食管癌根治术老年患者PPCs发生的独立危险因素,有助于提高ARISCAT评分预测PPCs发生的准确性。

Objective To evaluate the relationship between preoperative malnutrition and postoperative pulmonary complications(PPCs)in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods The elderly patients who underwent elective thoracoscopic and laparoscopic radical esophagectomy in the Affiliated Hospital of Jiangnan University were enrolled.The general clinical data and nutritional status,Assess Respiratory Risk in Surgical Patients in Catalonia(ARISCAT)score,tumor pathological stage and operation-related variables based on the Gobal Leader Initiative on Malnutrition criteria were recorded.The patients were divided into 2 groups according to whether PPCs occurred during hospitalization,and the differences between the variables were compared.Logistic regression analysis was used to identify the risk factors for PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.The accuracy of the ARISCAT score and ARISCAT score combined with malnutrition in predicting the occurrence of PPCs was evaluated by receiver operating characteristic curve.Results A total of 256 elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy were included,and the incidence of PPCs was 23.8%.There were no significant differences between patients with and without PPCs in FEV1/FVC,age,American Society of Anesthesiologists physical status,chronic obstructive pulmonary disease ratio,malnutrition ratio and ratio of patients with high ARISCAT score(P<0.05).The results of logistic regression analysis showed that increasing age,chronic obstructive pulmonary disease,malnutrition and high ARISCAT score were independent risk factors for PPCs.The area under the receiver operating characteristic curve of ARISCAT score and malnutrition combined with ARISCAT score in predicting the occurrence of PPCs was 0.722 and 0.777,respectively,and the difference was statistically significant(P<0.05).Conclusions Preoperative malnutrition is an independent risk factor for the occurrence of PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy,which is helpful in improving the accuracy of ARISCAT score in predicting the occurrence of PPCs.