老年肺癌患者胸腔镜术后心肺并发症预测模型的建立与分析*

目的通过分析老年肺癌患者电视胸腔镜手术(VATS)后心肺并发症的危险因素,建立列线图评价模型,并评价预测术后并发症的准确性。方法选择2015年1月-2018年1月该院胸外科收治的老年肺癌并行VATS术治疗的患者476例作为研究对象,将发生术后心肺并发症的患者166例作为并发症组、310例无心肺并发症的患者作为对照组。单因素分析发生并发症的相关因素,将有统计学意义的指标纳入多因素Logistic回归模型,分析老年肺癌患者VATS术后心肺并发症的危险因素。根据回归分析结果,建立列线图评价模型。利用Hosmer-Lemeshow检验评价模型预测效能。结果 Logistic回归分析显示,年龄(OR=1.337)、血糖(OR=4.647)和手术难度(OR=4.598)是发生术后并发症的危险因素,白蛋白(OR=0.660)是发生术后并发症的保护因素(P0.05)。列线图模型显示,随着年龄、血糖和手术难度地增加、白蛋白指标地降低,列线图模型相应评分也增高,对应的并发症发生风险上升。Hosmer-Lemeshow检验结果显示,列线图模型预测效能为81.93%(P=0.894)。结论基于年龄、血糖、手术难度和白蛋白建立预测老年肺癌患者VATS术后心肺并发症发生风险的列线图模型,具有良好的预测效能,临床价值较高。

Establishment and analysis of preoperative evaluation model for cardiopulmonary complications after VATS in elderly patients with lung cancer*

Abstract: Objective?To establish a preoperative evaluation model and evaluate the accuracy of postoperative cardiopulmonary complications by analyzing the risk factors of postoperative complications after VATS in elderly patients with lung cancer.?Methods?From January 2015 to January 2018, 476 patients underwent VATS were selected as subjects. Among them, 166 patients with postoperative cardiopulmonary complications were included as complications and 310 patients without cardiopulmonary complications served as a control group. Univariate analysis of the factors associated with complications, statistically significant indicators were included in the multivariate logistic regression model, and the risk factors for postoperative cardiopulmonary complications after VATS in elderly patients with lung cancer were analyzed. Based on the results of the regression analysis, a preoperative evaluation model was established. The Hosmer-Lemeshow test were used to evaluate the model prediction performance.?Results?Logistic regression analysis showed age (OR?=?1.337), Glu (OR?=?4.647), surgical size (OR?=?4.598) were risk factors for postoperative complications, Albumin (OR?=?0.660) was a protective factor for postoperative complications (P?