中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

急性肺损伤早期预测评分法在肺癌手术患者中的应用研究

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目的探讨三种肺损伤早期预测评分方法对筛选肺癌术后急性肺损伤(acute lung injury,ALI)高危患者的临床诊断价值。方法应用方便抽样法,对某三甲医院因肺癌行肺部手术患者的病历资料进行回顾性分析。按 ALI 诊断柏林标准分为术后发生 ALI 组和非 ALI 组。应用三种肺损伤早期预测评分方法进行评分,包括肺损伤评分系统(lung injury prediction score,LIPS)、术后肺损伤评分系统(surgical lung injury prediction,SLIP)和 SLIP-2。分别比较两组患者的评分结果的差异性;同时分析三种评分方法的相关性;绘制并分析患者评分结果的受试者工作特征(receiver operating characteristic,ROC)曲线。结果共纳入 400 例肺癌手术患者。术后发生 ALI 者 38 例(9.5%),其中 2 例进展为急性呼吸窘迫综合征入重症监护病房抢救,无死亡病例。发生 ALI 组患者的预测评分均高于非 ALI 组患者,差异有统计学意义(均 P<0.001),而且三种评分方法存在良好相关性(均P<0.001)。三种评分方法 ROC 曲线下面积(area under ROC curve,AUC)均大于 0.8,对早期预测肺癌术后 ALI 高危患者均具有较好诊断价值,其中 LIPS 的 AUC 为 0.833,95%CI(0.79,0.87),高于其他两种方法。结论LIPS、SLIP 与 SLIP-2 三种预测评分方法均可以应用于早期预测肺癌术后 ALI 高危患者,其中 LIPS 优于其他两种方法。

ObjectiveTo explore the clinical value of three early predictive scale of lung injury (ALI) in patients with high risk of acute lung injury (ALI) after lung cancer surgery.MethodsA convenient sampling method was used in this study. A retrospective analysis was performed on patients with lung cancer underwent lung surgery. The patients were divided into an ALI group and a non-ALI group according to ALI diagnostic criteria. Three kinds of lung injury predictive scoring methods were used, including lung injury prediction score (LIPS), surgical lung injury prediction (SLIP) and SLIP-2. The differences in the scores of the two groups were compared. The correlation between the three scoring methods was also analyzed. The diagnostic value was analyzed by drawing receiver operating characteristic (ROC) curves.ResultsA total of 400 patients underwent lung cancer surgery, and 38 patients (9.5%) developed ALI after operation. Among them, 2 cases progressed to acute respiratory distress syndrome and were treated in intensive care unit. There were no deaths. The predictive scores of the patients in the ALI group were higher than those in the non-ALI group, and the difference was statistically significant (all P<0.001). There was a good correlation between the three scoring methods (allP<0.001). The three scoring methods had better diagnostic value for early prediction of high risk ALI patients after lung cancer surgery and their area under ROC curve (AUC) were larger than 0.8. LIPS score performed better than others, with an AUC of 0.833, 95%CI (0.79, 0.87).ConclusionThree predictive scoring methods may be applied to early prediction of high risk ALI patients after lung cancer surgery, in which LIPS performs better than others.

关键词: 肺损伤预测评分; 急性肺损伤; 肺癌; 术后

Key words: Lung injury prediction score; Acute lung injury; Lung cancer; Postoperative

引用本文: 刘春燕, 徐仁华. 急性肺损伤早期预测评分法在肺癌手术患者中的应用研究. 中国呼吸与危重监护杂志, 2018, 17(2): 161-164. doi: 10.7507/1671-6205.201709002 复制

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