两种评分系统对腹部四级手术患者术后肺部并发症预测效果的对比研究

A Comparative Study of Two Different Scoring System for Predicting Postoperative Pulmonary Complications in Abdominal Four-Level Surgery Patients

目的比较ARISCAT(Assess Respiratory Risk in Surgical Patients in Catalonia)评分与BPRI(Brief Predictive Risk Index)评分对腹部四级手术患者术后肺部并发症的预测效果。方法回顾性收集重庆市某三甲医院2020年1月~2020年12月行腹部四级手术的患者,分别使用ARISCAT评分与BPRI评分对患者进行评分,通过受试者工作特征曲线(Receiver Operating Characteristic,ROC)及曲线下面积(Area Under Curve,AUC)、特异度、灵敏度评估模型的区分度,校准曲线评估模型的校准度,临床决策曲线评估模型临床净获益。结果本研究共纳入413名行腹部四级手术的患者,这些患者术后肺部并发症的发生率为60.8%,ARISCAT评分的AUC值为0.684(95%CI:0.632~0.736),大于BPRI评分的AUC值0.578(95%CI:0.522~0.635,P<0.001),ARISCAT评分和BPRI评分的特异度分别为0.778、0.772,灵敏度分别为0.514、0.359。在低危人群中,ARISCAT评分的校准度较好,而在高危人群中,BPRI评分的校准度更好。ARISCAT评分有更高的临床净获益。结论腹部四级手术患者术后肺部并发症的发生率高,ARISCAT评分和BPRI评分均能有效预测腹部四级手术患者发生术后肺部并发症的风险,临床上可灵活运用两个模型,并尽早采取措施,降低围术期患者肺部并发症的发生率。

Objective To compare the predictive effect of ARISCAT(Assess Respiratory Risk in Surgical Patients in Catalonia)score and BPRI(Brief Predictive Risk Index)score on postoperative pulmonary complications in patients undergoing abdominal four-level surgery.Methods Patients undergoing quadruple abdominal four-level surgery from January 2020 to December 2020 in a tertiary care hospital in Chongqing were retrospectively collected,and scored using the ARISCAT score and the BPRI score,respectively.The Receiver Operating Characteristic(ROC)curve and the area under curve(AUC),specificity,and sensitivity were used to assess the discrimination of the scoring system.The calibration curve was used to assess the calibration,and clinical decision curve was used to assess the net clinical benefit.Results A total of 413 patients undergoing abdominal four-level surgery were included in this study,and the incidence of postoperative pulmonary complications was 60.8%;the AUC value of the ARISCAT score was 0.684(95%CI:0.632~0.736),which was greater than the AUC value of the BPRI score of 0.578(95%CI:0.522~0.635,P<0.001).The specificity of the ARISCAT score and the BPRI score were 0.778 and 0.772,respectively,and the sensitivity were 0.514 and 0.359,respectively.the calibration of the ARISCAT score was better in the low-risk population,while the calibration of the BPRI score was better in the high-risk population.the ARISCAT score had a higher net clinical benefit.Conclusions The incidence of postoperative pulmonary complications in abdominal four-level surgery patients is high.Both the ARISCAT model and the BPRI model can effectively predict the risk of postoperative pulmonary complications in patients undergoing abdominal surgery.The two models can be used flexibly so that medical staff can take measures as early as possible to reduce the incidence of pulmonary complications.