Fisher Bruce W, Majumdar Sumit R, McAlister Finlay A
Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Am J Med. 2002 Feb 15;112(3):219-25. doi: 10.1016/s0002-9343(01)01082-8.
To determine the performance of variables commonly used in the prediction of postoperative pulmonary complications in patients undergoing nonthoracic surgery.
We conducted a systematic review of the literature in English, using MEDLINE (1966-2001), manual searches of identified articles, and contact with content experts. All studies reporting independent and blinded comparisons of preoperative or operative factors with postoperative pulmonary complications were included. Two reviewers independently abstracted inclusion and exclusion criteria, study designs, patient characteristics, predictors of interest, and the nature and occurrence of postoperative pulmonary complications.
Seven studies fulfilled the inclusion criteria. The definition of postoperative pulmonary complications differed among studies, and the incidence of postoperative pulmonary complications varied from 2% to 19%. Of the 28 preoperative or operative predictors that were evaluated in the 7 studies, 16 were associated significantly with postoperative pulmonary complications, although only 2 (duration of anesthesia and postoperative nasogastric tube placement) were significant in more than one study. The positive (2.2 to 5.1) and negative (0.2 to 0.8) likelihood ratios for these 16 variables suggest that they have only modest predictive value. Neither hypercarbia nor reduced spirometry values were independently associated with an increased risk of postoperative pulmonary complications.
Few studies have rigorously evaluated the performance of the preoperative or operative variables in the prediction of postoperative pulmonary complications. Prospective studies with independent and blinded comparisons of these variables with postoperative outcomes are needed.
确定非胸科手术患者术后肺部并发症预测中常用变量的性能。
我们使用MEDLINE（1966 - 2001年）对英文文献进行了系统回顾，对已识别文章进行手工检索，并与内容专家进行联系。纳入所有报告术前或手术因素与术后肺部并发症进行独立且盲法比较的研究。两名审阅者独立提取纳入和排除标准、研究设计、患者特征、感兴趣的预测因素以及术后肺部并发症的性质和发生率。
七项研究符合纳入标准。各研究中术后肺部并发症的定义不同，术后肺部并发症的发生率在2%至19%之间。在这七项研究中评估的28个术前或手术预测因素中，有16个与术后肺部并发症显著相关，尽管只有2个（麻醉持续时间和术后鼻胃管放置）在不止一项研究中具有显著性。这16个变量的阳性似然比（2.2至5.1）和阴性似然比（0.2至0.8）表明它们的预测价值有限。高碳酸血症和肺功能测定值降低均与术后肺部并发症风险增加无独立相关性。
很少有研究严格评估术前或手术变量在预测术后肺部并发症方面的性能。需要进行前瞻性研究，对这些变量与术后结果进行独立且盲法比较。
