老年营养风险指数与胸腔镜肺切除术老年患者术后肺部并发症的关系
Relationship between Geriatric Nutritional Risk Index and postoperative pulmonary complications in elderly patients undergoing thoracoscopic lung resection
胡薇 1水维康 2高雅 3马文文 1朱珊珊1
作者信息
- 1. 徐州市肿瘤医院麻醉科,徐州 221005
- 2. 徐州医科大学江苏省麻醉学重点实验室 徐州医科大学江苏省麻醉与镇痛应用技术重点实验室,徐州 221004
- 3. 江苏大学医学院,镇江 212013
- 折叠
摘要
目的 评价老年营养风险指数(GNRI)与胸腔镜肺切除术老年患者术后肺部并发症(PPCs)的关系.方法 选择徐州市肿瘤医院2022年7月至2023年9月择期行胸腔镜下肺切除术老年患者291例,性别不限,年龄≥60岁,ASA分级Ⅰ-Ⅲ级,根据受试者工作特征曲线确定的GNRI(以连续型变量表示)预测PPCs的最佳截断值将患者分为高GNRI组和低GNRI组.记录患者术后7 d内PPCs的发生情况.采用logistic回归评价GNRI与PPCs的关系.采用限制性立方样条图评价GNRI评分(以连续变量表示)与PPCs之间是否存在非线性关系.通过曲线下面积[95％可信区间(CI)]评价GNRI(以分类型变量表示)、加泰罗尼亚外科患者呼吸风险(ARISCAT)评分以及二者联合预测PPCs发生的准确性.结果 最终纳入269例患者,高GNRI组(GNRI≥100.9)114例,低GN-RI 组(GNRI＜100.9)155 例.与高 GNRI 组相比,低 GNRI 组 PPCs 发生率升高(42.6％vs 16.7％,P＜0.001).多因素logistic回归分析显示,低GNRI是胸腔镜肺切除术老年患者PPCs的危险因素,而GNRI评分升高是PPCs的保护因素(P＜0.05).限制性立方样条图显示,GNRI评分与PPCs发生风险存在线性关系(P=0.947).GNRI、ARISCAT评分及两者联合预测PPCs的曲线下面积分别为0.646(95％CI 0.589～0.704)、0.619(95％CI 0.564～0.674)和 0.708(95％CI 0.647～0.769).结论 低 GNRI是胸腔镜肺切除术老年患者PPCs的危险因素,而GNRI评分升高是PPCs的保护因素;GNRI联合ARISCAT评分可预测PPCs的发生.
Abstract
Objective To evaluate the relationship between the Geriatric Nutritional Risk Index(GNRI)and postoperative pulmonary complications(PPCs)in elderly patients undergoing thoracoscopic lung resection.Methods Two hundred and ninety-one elderly patients of either sex,aged ≥60 yr,of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ,undergoing elective thoracoscopic lung resection at Xuzhou Cancer Hospital from July 2022 to September 2023,were selected.Patients were divided into high GNRI group or low GNRI group based on the optimal cutoff value of GNRI(represented as a continuous variable)determined by the receiver operating characteristic curve to predict PPCs.The occur-rence of PPCs was compared between the two groups within the first 7 postoperative days.The relationship between GNRI and PPCs was evaluated by the logistic regression analysis.The nonlinear correlation between GNRI score(expressed as a continuous variable)and PPCs was investigated by the restricted cubic spline.The accuracy of the GNRI,Assess Respiratory Risk in Surgical Patients in Catalonia(ARISCAT)score,and combination of the two in predicting the occurrence of PPCs was evaluated by the areas under the ROC curve(95％confidence interval[CI]).Results A total of 269 patients were finally included,with 114 in high GNRI group(GNRI≥100.9)and 155 in low GNRI group(GNRI＜100.9).Compared with high GNRI group,the incidence of PPCs was significantly increased compared with low GNRI group(42.6％vs 16.7％,P＜0.001).The multivariate logistic regression analysis showed that low GNRI was a risk factor for PPCs,while elevated GNRI score was a protective factor for PPCS in elderly patients undergoing thoracoscopic lung resection(P＜0.05).The restricted cubic spline showed a linear correlation between GNRI score and PPCs(P=0.947).The areas under the receiver operating characteristic curves of the GNRI,ARISCAT score,and combination of the two in predicting PPCs were 0.646(95％CI 0.589-0.704),0.619(95％CI 0.564-0.674)and 0.708(95％CI 0.647-0.769),respectively.Conclusions Low GNRI is an independent risk factor for PPCs in elderly patients undergoing thoracoscopic lung resection,while elevated GNRI score is a protective factor.The combination of GNRI and ARISCAT score can predict the occurrence of PPCs.
关键词
老年人/肺切除术/术后并发症/老年营养风险指数Key words
Aged/Pneumonectomy/Postoperative complications/Geriatric nutritional risk index引用本文复制引用
基金项目
2022年徐州市推动科技创新项目(KC22149)
出版年
2024
NETL
NSTL
万方数据