脊柱手术后肺部并发症的危险因素分析和风险评估表的建立

Risk factors and the risk assessment table of pulmonary complications after spinal surgery

目的探讨脊柱手术后患者发生肺部并发症的危险因素,并建立脊柱手术后肺部并发症风险评估表。方法收集接受脊柱手术治疗的627例患者的临床资料,对脊柱手术后肺部并发症危险因素进行单因素分析,将有统计学意义的变量以及临床专家建议单的因素纳入非条件二项分类logistic回归分析,用ROC曲线下的面积(AUC)评价logistic回归模型的效果,根据回归模型统计的结果建立脊柱手术后肺部并发症的风险评估表。结果627例脊柱手术后患者49例发生肺部并发症(7.81%);单因素分析显示,患者年龄、BMI、吸烟、高血压、糖尿病、脊柱疾病类型、手术类型、手术部位、手术时限、美国麻醉师协会评分(ASA评分)、住院时间及术前住院时间,差异均有统计学意义(P<0.05);logistic回归分析显示,年龄、BMI、吸烟、糖尿病、脊柱疾病类型、手术类型、手术部位、ASA评分、麻醉类型及住院时间是脊柱手术后肺部并发症的独立危险因素(P<0.05);AUC为0.883,95%可信区间为0.843~0.923;建立的风险评估表包括术前和术后评估指标,得分越高,脊柱手术后发生肺部并发症的风险越高。结论建立了脊柱手术后发生肺部并发症的风险评估表,评估表的评分越高,脊柱手术后发生肺部并发症的风险越高。

Objective To determine the risk factors of pulmonary complications in the patients after spinal surgery,and to establish the risk assessment table for pulmonary complications after spinal surgery.Methods The data of 627 patients with spinal surgery were collected,and the risk factors of pulmonary complications after spinal surgery were analyzed by univariate analysis,the variables with statistical significance and the factors put forward by clinical experts were included in the non-conditional binomial logistic regression analysis.The area under the ROC curve(AUC)was used to evaluate the effect of the logistic regression model,and the risk assessment table for pulmonary complications after spinal surgery was established based on the results of the regression model.Results Postoperative pulmonary complications occurred in 49 patients(7.81%).A univariate analysis showed that there were statistical differences in age,body mass index(BMI),smoking,hypertension,diabetes,type of spinal disease,type of operation,surgical site,operation time,American Society of Anesthesiologists(ASA)scores,anesthesia type and time of hospital stay(P<0.05).The risk assessment,including preoperative and postoperative evaluation indicators,was quantified and scored.The highest preoperative and postoperative assessment scores were 21 and 20,respectively.Conclusions The risk factors for pulmonary complications after spinal surgery were identified and the risk assessment table for identifying high-risk patients was established in this study.The higher scores that the risk assessment table indicate,the higher risk of pulmonary complications after spine surgery.