60岁以上胸腔镜肺叶切除术患者术后肺部并发症现状及其预测模型研究

Current status of postoperative pulmonary complications and their predictive modeling in patients over 60 years of age undergoing thoracoscopic lobectomy

目的探讨行胸腔镜肺叶切除术的60岁以上患者术后肺部并发症(PPCs)发生现状并构建预测模型,以期为临床提供参考意见。方法选取自2020年6月至2023年12月哈尔滨医科大学附属第一医院行胸腔镜肺叶切除术的328例肺癌患者为研究对象,根据是否发生PPCs,将患者分为PPCs组和非PPCs组。收集两组患者的临床资料,采用多因素Logistic回归分析PPCs发生的影响因素,并根据筛选的影响因素构建预测模型。结果在328例肺癌患者中,PPCs组83例(25.3%)、非PPCs组245例(74.7%)。单因素分析结果显示,与非PPCs组比较,PPCs组患者年龄>75岁、糖尿病、慢性阻塞性肺疾病、低白蛋白血症、新辅助放化疗、术前衰弱、营养不良的比例升高,血红蛋白、术前肺康复训练的比例降低,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄>75岁(OR=1.598,95%可信区间:1.167~2.189)、术前衰弱(OR=1.657,95%可信区间:1.235~2.224)、营养不良(OR=1.846,95%可信区间:1.259~2.706)、低白蛋白血症(OR=1.677,95%可信区间:1.253~2.245)是PPCs发生的独立危险因素,术前肺康复训练为其保护因素(OR=0.522,95%可信区间:0.377~0.722)。受试者工作特征曲线分析显示,模型预测PPCs发生风险的曲线下面积为0.861(95%可信区间:0.812~0.909),敏感度为83.87%,特异度为78.16%。结论60岁以上老年肺癌患者PPCs发生风险较高,高龄、营养不良、术前衰弱、低白蛋白血症可增加PPCs发生风险,而术前进行肺康复训练可有效提高肺功能,降低PPCs发生率,据此构建的预测模型可预测PPCs发生风险。

Objective To explore the current situation of postoperative pulmonary complications(PPCs)in patients over 60 years of age who underwent thoracoscopic lobectomy and to construct a prediction model,with a view to providing clinical reference opinions.Methods A total of 328 lung cancer patients who underwent thoracoscopic lobectomy in the First Hospital of Harbin Medical University from June 2020 to December 2023 were selected as study subjects.According to whether PPCs occurred,the patients were divided into PPCs group and non-PPCS group.The clinical data of patients in the two groups were collected,and the influencing factors of the occurrence of PPCs were analyzed by multifactorial Logistic regression,and a prediction model was constructed based on the screened influencing factors.Results Among the 328 lung cancer patients,83(25.3%)were in the PPCs group and 245(74.7%)were in the non-PPCs group.The results of univariate analysis showed that compared with the non-PPCs group,the proportion of patients in the PPCs group with age>75 years,diabetes mellitus,chronic obstructive pulmonary disease,hypoalbuminemia,neoadjuvant radiotherapy,preoperative debilitation,and the proportion of malnutrition increased,and the proportion of hemoglobin and preoperative pulmonary rehabilitation training decreased,with a statistically significant difference(P<0.05).The results of multifactorial Logistic regression analysis showed that age>75 years(OR=1.598,95%confidence interval:1.167-2.189),preoperative debility(OR=1.657,95%confidence interval:1.235-2.224),malnutrition(OR=1.846,95%confidence interval:1.259-2.706),low albuminemia(OR=1.677,95%confidence interval:1.253-2.245)were independent risk factors for the development of PPCs,and preoperative pulmonary rehabilitation training was a protective factor(OR=0.522,95%confidence interval:0.377-0.722).The receiver operating characteristic curve analysis showed that the model predicted the risk of the development of PPCs with an area under the curve of 0.861(95%confidence interval:0.812-0.909),with a sensitivity of 83.87%and a specificity of 78.16%.Conclusion Elderly lung cancer patients over 60 years of age have a higher risk of PPCs,and advanced age,malnutrition,preoperative debility,and hypoalbuminemia can increase the risk of PPCs,while preoperative pulmonary rehabilitation training can effectively improve lung function and reduce the incidence of PPCs,and the prediction model constructed accordingly can predict the risk of PPCs.