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| 氨基末端脑钠肽对老年患者非心脏手术后肺部并发症的预测价值 |
| Predictive value of amino-terminal brain natriuretic peptide for postoperative pulmonary complications in elderly patients undergoing non-cardiac surgery |
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| DOI：10.12089/jca.2023.10.002 |
| 中文关键词: 氨基末端脑钠肽 术后肺部并发症 老年 预测价值 |
| 英文关键词: Amino-terminal brain natriuretic peptide Postoperative pulmonary complications Aged Predictive value |
| 基金项目:“十三五”国家重点研发项目（2018YFC2001800） |
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| 中文摘要: |
目的 评估术前氨基末端脑钠肽（NT-pro BNP）对老年患者非心脏手术后肺部并发症（PPCs）的预测价值。
方法 前瞻性收集行非心脏手术老年患者174例，男118例，女56例，年龄≥65岁，ASA Ⅰ—Ⅲ级。于术前2 h测定静脉血中NT-pro BNP水平，采用全子集回归进行变量筛选，多因素Logistic回归构建模型。通过受试者工作特征曲线下（AUC）面积和决策分析曲线评价术前NT-pro BNP对PPCs的预测价值。
结果 有22例（12.6%）患者发生PPCs。全子集回归分析筛选出最终变量，纳入多因素Logistic回归模型中的变量为性别、ASA分级、胰腺手术、胃肠手术、泌尿手术、活动耐量、屏气试验分级、总输液量和术前NT-pro BNP。加入术前NT-pro BNP后，多因素Logistic回归模型的AUC由0.777增加至0.815（P<0.05）。决策分析曲线结果显示，在所有风险决策阈值下，加入术前NT-pro BNP后，多因素Logistic回归模型均可获得临床净获益。
结论 术前NT-pro BNP是老年患者非心脏手术PPCs的独立预测因子，可显著改善模型的预测性能，获得临床净获益，实现对老年患者非心脏手术PPCs的早期精准预测及风险分层。 |
| 英文摘要: |
Objective To assess the predictive value of preoperative amino-terminal brain natriuretic peptide (NT-pro BNP) for postoperative pulmonary complications (PPCs) in elderly patients undergoing non-cardiac surgery.
Methods Data were prospectively collected from 174 elderly patients undergoing non-cardiac surgery, 118 males and 56 females, aged ≥ 65 years, ASA physical status Ⅰ-Ⅲ. NT-pro BNP levels were measured 2 hours before surgery. Full subset regression was used for variable screening, and multivariable logistic regression was used to construct the model. The predictive value of preoperative NT-pro BNP for PPCs was evaluated by area under the receiver operating characteristic curve (AUC) and decision analysis curve.
Results PPCs occurred in 22 patients (12.6%). Full subset regression analyses were performed to screen the final variables, which were ultimately included in the multivariable logistic regression model as gender, ASA physical status, pancreatic surgery, gastrointestinal surgery, urological surgery, activity tolerance grade, breath-holding test classification grade, total fluid volume, preoperative NT-pro BNP. The preoperative NT-pro BNP increased the AUC of the multivariable logistic regression model from 0.777 to 0.815 (P < 0.05). The results of the decision analysis curves showed a net clinical benefit from the multivariable Logistic regression model after the addition of preoperative NT-pro BNP at all risk decision thresholds.
Conclusion The current limited data available suggests that preoperative NT-pro BNP is an independent predictor of PPCs in elderly patients with non-cardiac surgery, which can significantly improve the predictive performance of the model and obtain a net clinical benefit, ensuring early and accurate prediction and risk stratification of non-cardiac surgery PPCs in elderly patients. |
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