Ⅰ期老年非小细胞肺癌患者胸腔镜术后主要并发症影响因素的分析及预测模型的构建-现代医学

Ⅰ期老年非小细胞肺癌患者胸腔镜术后主要并发症影响因素的分析及预测模型的构建

单位：十堰市太和医院心肺康复中心, 湖北十堰 442000

分类号：R734.2;R655

出版年·卷·期（页码）：2021·49·第一期（69-74）

摘要：

目的： 研究影响Ⅰ期老年非小细胞肺癌患者胸腔镜术（VATS）后发生主要并发症的危险因素及预测模型的构建。方法： 选取2012年2月至2019年3月在本院胸外科行VATS的806例Ⅰ期老年非小细胞肺癌患者，根据是否发生主要并发症分为主要并发症组（n=51）和无主要并发症组（n=755）。分析两组患者并发症发生情况和临床资料。采用单因素分析比较两组患者年龄、性别、吸烟史、肺部感染、合并症、肺功能、病理类型等，对有差异的因素进行Logistic多因素分析，建立主要并发症的全变量风险预测模型，并通过ROC曲线验证预测有效性。结果： 51例出现主要并发症的患者中，以肺部和心脑血管并发症为主。单因素分析显示，性别（χ²=10.861，P=0.001）、吸烟史（χ²=4.351，P=0.037）、肺部感染（χ²=7.992，P=0.005）、合并症（χ²=22.909，P<0.001）、FEV1（t=3.334，P=0.013）、FEV1%（t=5.599，P<0.001）、手术持续时间（t=6.687，P=0.007）、出血量（t=5.990，P=0.024）是影响老年非小细胞肺癌患者行VATS后发生主要并发症的影响因素。多因素分析显示，肺部感染（OR=4.302，95%CI：3.670~5.042）、合并症（OR=1.863，95%CI：1.348~2.574）、手术时间（OR=5.546，95%CI：4.332~7.099）、出血量（OR=6.098，95%CI：3.908~9.515）是影响老年非小细胞肺癌患者VATS后主要并发症发生的独立危险因素。用Enter法建立主要并发症临床预测模型为：P=1/（1+e-y），y=-3.140+1.459×肺部感染+0.622×合并症+1.713×手术时间+1.909×出血量。ROC曲线下面积为0.973，95%CI为0.948~0.997，灵敏度为82.0%，特异度为84.2%。结论： 肺部感染、合并症、手术时间、出血量是影响Ⅰ期老年非小细胞肺癌患者VATS后发生主要并发症的独立危险因素，这四者联合能较好地预测主要并发症的发生。

Objective: By analyzing the clinical data of patients with stage I non-small-cell lung cancer (NSCLC) under treatment of video-assisted thoracic surgery (VATS), this study aims to explore the predict value and impacts of the major complications. Methods: A total of 806 patients diagnosed as stage Ⅰ NSCLC and received VATS were enrolled from February 2012 to March 2019 in our hospital. Patients were divided into major complications group (n=51) and non-major-complications group (n=755). Comparing the clinical data between the patients in the two groups, such as age, gender, smoking, pulmonary infection and pulmonary functions by single factor analysis. The multi-factor analysis was performed to explore the risk factors and prediction model of major complications.Results: The primary complications were pulmonary and cardiovascular complications. Gender (χ²=10.861,P=0.001), smoking(χ²=4.351,P=0.037), lung infection before operation (χ²=7.992,P=0.005), complications before operation (χ²=22.909,P<0.001), FEV1(t=3.334, P=0.013), FEV1%(t=5.599, P<0.001), operation time (t=6.687, P=0.007), blood loss(t=5.990, P=0.024) showed significantly differences between the two groups. The multi-factor analysis showed that lung infection before operation(OR=4.302, 95%CI:3.670-5.042), complications before operation(OR=1.863, 95%CI:1.348-2.574), operation time (OR=5.546, 95%CI:4.332-7.099), blood loss (OR=6.098, 95%CI:3.908-9.515)were the independent risk factors of major complications after VATS. The prediction model acquired using the Enter for major complications was P=1/(1+e-y),y=-3.140+1.459×lung infection before operation+0.622×complications before operation+1.713×operation time+1.909×blood looss. The area under ROC curve was 0.973, with the 95%CI being 0.948-0.997, sensitivity being 82.0%, specificity being 84.2%. Conclusion: Lung infection before operation, complications before operation, operation time, blood loss were the independent risk factors of major complications after VATS in elderly patients with stage Ⅰ NSCLC. These factors have the potential to predict major complications.

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