术后第一天测得的第一秒用力呼气容积（FEV1），而非预计术后第一秒用力呼气容积（ppoFEV1），是肺切除术后心肺并发症的最佳预测指标。
Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection.
作者信息
Varela Gonzalo, Brunelli Alessandro, Rocco Gaetano, Novoa Nuria, Refai Majed, Jiménez Marcelo F, Salati Michele, Gatani Tindaro
机构信息
Service of Thoracic Surgery, Salamanca University Hospital, 37007 Salamanca, Spain.
出版信息
Eur J Cardiothorac Surg. 2007 Mar;31(3):518-21. doi: 10.1016/j.ejcts.2006.11.036. Epub 2006 Dec 22.
INTRODUCTION AND OBJECTIVE
There is a low correlation between predicted postoperative FEV1 (ppoFEV1) and FEV1 measured the days after pulmonary resection, when most complications are developed. The hypothesis of this investigation is that ppoFEV1 does not predict postoperative morbidity in patients undergoing lung resection when immediate postoperative FEV1 is considered in the predictive model.
METHODS
One hundred ninety-eight consecutive patients undergoing lobectomy or pneumonectomy were included in a prospective, multiinstitutional study.
INDEPENDENT VARIABLES
age, body mass index, ppoFEV1, surgical approach (VATS or muscle-sparing thoracotomy), type of analgesia (epidural or intraveous), postoperative visual analogue pain score and FEV1 measured the day after the operation. Target variable: occurrence of postoperative cardio-respiratory complications. Method of analysis: classification tree (CART) dividing the population at random in two subsets and developing a bootstrap set of 100 trees resampling training data. The relative importance of each variable and the accuracy of both initial and committee trees to predict the outcome were presented.
RESULTS
One hundred seventy-seven lobectomies and 21 pneumonectomies were included. Overall cardio-respiratory morbidity was 22%. According to CART results, first day FEV1 was the most important variable to classify cases as primary splitter and as a surrogate of each primary splitter (100% importance). Patient age followed (51%) and ppoFEV1 was third (43%) with a score similar to postoperative pain score (42%) and type of analgesia (36%). Sensitivity and specificity of the initial tree were, respectively, 0.5 and 0.7; values for committee tree were 0.5 sensitivity and 0.7 specificity.
CONCLUSION
Postoperative cardio-respiratory complications are more related to FEV1 measured in the first postoperative day than to ppoFEV1 value.
引言与目的
在大多数并发症发生的肺切除术后数天所测量的第一秒用力呼气容积（FEV1）与预测的术后FEV1（ppoFEV1）之间存在较低的相关性。本研究的假设是，当在预测模型中考虑术后即刻FEV1时，ppoFEV1不能预测肺切除患者的术后发病率。
方法
198例连续接受肺叶切除术或全肺切除术的患者纳入一项前瞻性、多机构研究。
自变量
年龄、体重指数、ppoFEV1、手术方式（电视辅助胸腔镜手术或保留肌肉的开胸手术）、镇痛类型（硬膜外或静脉）、术后视觉模拟疼痛评分以及术后第一天测量的FEV1。目标变量：术后心肺并发症的发生情况。分析方法：分类树（CART），将研究对象随机分为两个亚组，并通过对训练数据进行重采样生成100棵树的自举集。呈现每个变量的相对重要性以及初始树和委员会树预测结果的准确性。
结果
包括177例肺叶切除术和21例全肺切除术。总体心肺发病率为22%。根据CART结果，术后第一天的FEV1是将病例分类为主要分割点以及作为每个主要分割点替代指标的最重要变量（重要性为100%）。其次是患者年龄（51%），ppoFEV1排第三（43%），得分与术后疼痛评分（42%）和镇痛类型（36%）相似。初始树的敏感性和特异性分别为0.5和0.7；委员会树的敏感性值为0.5，特异性值为0.7。
结论
术后心肺并发症与术后第一天测量的FEV1的相关性高于与ppoFEV1值的相关性。
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