三种术后肺部并发症评估标准的临床效果比较

Comparison of clinical effects of three criteria for postoperative pulmonary complications

目的比较三种术后肺部并发症(PPCs)评估标准的临床效果。方法回顾性分析2021年1月至7月在四川大学华西医院行胸腔镜肺切除术患者的临床资料,分别应用2008年墨尔本团队评分(MGS)标准、2015年欧洲围术期临床结局(EPCO)标准和2018年围术期医疗标准化终点(StEP)标准评估PPCs。根据上述标准将患者分为PPCs组和非PPCs组。记录3种标准的PPCs诊断率,采用Kappa检验评价不同标准诊断结果的一致性。采用logistic回归分析评估不同标准诊断的PPCs与不良预后事件发生风险的关系。结果最终纳入397例患者。MGS标准PPCs诊断率明显低于EPCO标准和StEP标准(P<0.001),EPCO标准PPCs诊断率高于StEP标准(P<0.001)。EPCO标准与StEP标准的诊断一致性较好(κ=0.624,P<0.001),而EPCO标准、StEP标准与MGS标准诊断一致性均较差(κ=0.101,P<0.001;κ=0.210,P<0.001)。单因素和多因素logistic回归分析显示,EPCO标准和StEP标准诊断的PPCs可增加不良预后事件的发生风险(P<0.001)。结论EPCO标准和StEP标准用于胸腔镜肺切除术患者PPCs诊断和评估预后的价值优于MGS标准,EPCO标准的诊断敏感性最高。

Objective To compare the clinical effects of the three criteria for postoperative pulmonary complications(PPCs).Methods The clinical data of patients underwent thoracoscopic lung resection between January 2021 and July 2021 in our hospital were retrospectively analyzed.PPCs were assessed using the Melbourne Group Scale(MGS),European Perioperative Clinical Outcome(EPCO)and Standardized Endpoints for Perioperative Medicine(StEP)criteria.The patients were divided into PPC group and non-PPC group according to the above criteria.The diagnostic rates of PPCs of the three criteria were recorded.Cohen′s weighted kappa coefficient was used to evaluate the agreement between the three criteria.Logistic regression method was used to analyze the association between PPCs diagnosed by different criteria and risk of adverse prognostic events developed.Results A total of 397 patients who underwent thoracoscopic lung surgery were included in this study.The rate of PPCs diagnosed by MGS criterion was significantly lower than those by EPCO and StEP criteria(P<0.001),and the rate of PPCs diagnosed by EPCO criterion was significantly higher than those by StEP criterion(P<0.001).The diagnostic agreement between EPCO criterion and StEP criterion was good(κ=0.624,P<0.001),while the diagnostic agreement between EPCO criterion,StEP criterion and MGS criterion was poor(κ=0.101,P<0.001;κ=0.210,P<0.001).Univariate and multivariate logistic regression analysis showed that PPCs diagnosed by EPCO and StEP criteria increased the risk of adverse prognostic events developed(P<0.001).Conclusions The EPCO and StEP criteria are superior to MGS criterion with regard to the diagnostic and prognostic value for pulmonary complications following thoracoscopic lung resection,and the EPCO criterion had a higher sensitivity.