改良衰弱指数对胸腔镜肺叶切除术老年患者术后肺部并发症的预测价值

Predictive power of modified frailty index model for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic lobectomy

目的评估改良衰弱指数(mFI)对胸腔镜肺叶切除术老年患者术后肺部并发症(PPCs)的预测价值。方法回顾性收集胸腔镜肺叶切除术老年患者资料674例,男357例,女317例,年龄65~80岁,BMI<30 kg/m^(2),ASAⅠ—Ⅲ级。评估术后住院期间的PPCs发生情况,根据是否发生PPCs将患者分为两组:PPCs组和非PPCs组。将单因素回归分析中P<0.1的因素纳入多因素Logistics回归分析,筛选PPCs的独立危险因素。通过受试者工作特征曲线下面积(AUC)评价mFI对PPCs的预测价值。结果有108例(16%)患者发生PPCs。单因素分析显示,与非PPCs组比较,PPCs组ASA分级、ARISCAT评分和mFI明显升高(P<0.05),Hb<100 g/L及术前SpO_(2)<95%比例明显升高(P<0.05),单肺通气时间明显延长(P<0.05)。多因素Logistic回归分析显示,术前mFI升高(OR=2.28,95%CI 1.75~4.52,P=0.007)是PPCs发生的独立危险因素。ROC曲线显示,mFI的预测效能(AUC=0.90,95%CI 0.87~0.93,P=0.001)优于ARISCAT评分(AUC=0.81,95%CI 0.70~0.93,P=0.036)。结论术前mFI升高是老年肺叶切除手术患者发生PPCs的独立危险因素,应积极制定以改善衰弱为导向的围术期干预措施,以期降低PPCs的发生率。

Objective To evaluate the predictive power of the modified frailty index(mFI)for postoperative pulmonary complications(PPCs)following video-assisted thoracoscopic lobectomy in the elderly.Methods A total of 674 patients,357 males and 317 females,aged 65-80 years,BMI<30 kg/m^(2),ASA physical statusⅠ-Ⅲwho underwent video-assisted thoracoscopic lobectomy were retrospectively enrolled.The PPCs were assessed and the patients were divided into two groups:PPCs group and non-PPCs group.The predictive power of mFI for PPCs was evaluated by area under the receiver operating curve(AUC).Results PPCs occurred in 108 patients(16%).Univariate analysis showed that compared with non-PPCS group,ASA physical status,ARISCAT score and mFI were significantly higher in PPCs group(P<0.05),Hb<100 g/L and the proportion of SpO_(2)<95%were significantly higher(P<0.05),single lung ventilation time was significantly longer(P<0.05).The multivariable logistic regression further showed that mFI increased(OR=2.28,95%CI 1.75-4.52,P=0.007)was an independent risk factor for PPCs.The predictive power of mFI(AUC=0.90,95%CI 0.87-0.93,P=0.001)was superior to ARISCAT score(AUC=0.81,95%CI 0.70-0.93,P=0.036).Conclusion The elderly with mFI increased were at higher risk of developing PPCs after VATS lobectomy,perioperative prophylactic strategies to minimize the occurrence of PPCs should be formulated for the frail population.