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| 肿瘤细胞减灭术联合腹腔热灌注化疗术后肺部并发症的影响因素 |
| Factors influencing postoperative pulmonary complications in patients undergoing cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy |
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| DOI：10.12089/jca.2023.10.005 |
| 中文关键词: 目标导向液体治疗 肿瘤细胞减灭术 腹腔热灌注化疗术 肺部并发症 列线图 |
| 英文关键词: Goal-directed fluid therapy Cytoreductive surgery Intraperitoneal hyperthermic perfusion chemotherapy Pulmonary complications Nomogram |
| 基金项目:北京市科委首都特色研究（Z161100000516158） |
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| 中文摘要: |
目的 探讨肿瘤细胞减灭术联合腹腔热灌注化疗术（HIPEC）患者术后肺部并发症（PPCs）的危险因素，并构建列线图和单变量偏依赖图。
方法 收集2019年1月至2020年6月行肿瘤细胞减灭术联合腹腔热灌注化疗298例患者的临床资料，男122例，女176例，年龄18~80岁，BMI>18 kg/m2，ASA Ⅰ—Ⅲ级。采用逐步回归分析筛选PPCs的影响因素，建立Logistic回归模型并绘制列线图。
结果 有106例（35.6%）患者发生PPCs。逐步回归分析显示，手术时间（OR=1.383, 95%CI 1.022~1.943）、失血量（OR=1.003, 95%CI 1.001~1.005）、红细胞输注量（OR=0.997, 95%CI 0.994~0.999）、进行液体管理时参考的每搏变异度（SVV）值（OR=0.034, 95%CI 0.009~0.089）是PPCs的影响因素。将上述影响因素纳入Logistic回归模型构建列线图，R2=0.912；拟合优度检验χ2=10.673，P=0.2209；C-Index=0.991；准确度=0.9799；Kappa=0.9563；F1值=0.972。
结论 肿瘤细胞减灭术联合HIPEC患者PPCs的影响因素为手术时间、失血量、红细胞输注量和SVV值。列线图预测模型具有良好的区分度与准确度，能很好地运用于肿瘤细胞减灭术联合HIPEC患者PPCs的预测。 |
| 英文摘要: |
Objective To explore the factors related to postoperative pulmonary complications (PPCs) in patients undergoing cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy, and construct nomogram and univariate partial dependenceprofile.
Methods The perioperative information of 298 patients, 122 males and 176 females, aged 18-80 years, BMI > 18 kg/m2, and ASA physical status Ⅰ-Ⅲ, who underwent intraperitoneal hyperthermic chemotherapy from January 2019 to June 2020 were collected. The influence factors of PPCs were screened by stepwise regression analysis, the Logistic regression model was established and the column graph was drawn.
Results Stepwise regression analysis showed that operation time (OR = 1.383, 95% CI 1.022-1.943), blood loss (OR = 1.003, 95% CI 1.001-1.005), transfusion volume of suspended red blood cells (OR = 0.997, 95% CI 0.994-0.999) and stroke variability (SVV) referenced in fluid management (OR = 0.034, 95% CI 0.009-0.089) were influence factors for PPCs. Using independent influence factors incorporate Logistic regression model to construct nomogram, R2 = 0.912; Hosmer-Lemeshow test χ2=10.673, P = 0.2209; C-Index = 0.991; Accuracy = 0.9799; Kappa = 0.9563; F1 score = 0.972.
Conclusion Influence factors for PPCs are operative time, blood loss, suspension red blood cell transfusion, and SVV. The nomogram prediction model has good discrimination and accuracy, and can be well applied to the prediction of PPCs in patients undergoing cytoreductive surgery combined with intraperitoneal hyperperfusion chemotherapy. |
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