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胸腺瘤肌无力患者胸腺切除术后长时间通气的危险因素。

Risk factors of prolonged ventilation after thymectomy in thymoma myasthenia gravis patients.

机构信息

Department of Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China.

Department of Thoracic Surgery, Peking University People's Hospital, Beijing, People's Republic of China.

出版信息

J Cardiothorac Surg. 2021 Sep 27;16(1):275. doi: 10.1186/s13019-021-01668-8.

Abstract

BACKGROUND

To explore the risk factors for prolonged ventilation after thymectomy in patients with thymoma associated with myasthenia gravis (TAMG).

METHODS

We reviewed the records of 112 patients with TAMG after thymectomy between January 2010 and December 2019 in Peking University People's Hospital. Demographic, pathological, preoperative data and the Anesthesia, surgery details were assessed with multivariable logistic regression analysis to predict the risk of prolonged ventilation after thymectomy. A nomogram to predict the probability of post-thymectomy ventilation was constructed with R software. Discrimination and calibration were employed to evaluate the performance of the nomogram.

RESULTS

By multivariate analysis, male, low vital capacity (VC), Osserman classification (IIb, III, IV), total intravenous anesthesia, and long operation time were identified as the risk factors and entered into the nomogram. The nomogram showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0. 835 (95% confidence interval [CI], 0.757-0.913). The calibration plot indicated that the nomogram-predicted probabilities compared very well with the actual probabilities (Hosmer-Lemeshow test: P = 0.921).

CONCLUSION

The nomogram is a valuable predictive tool for prolonged ventilation after thymectomy in patients with TAMG.

摘要

背景

探讨胸腺瘤合并重症肌无力(TAMG)患者胸腺切除术后长时间通气的危险因素。

方法

我们回顾了 2010 年 1 月至 2019 年 12 月期间在北京大学人民医院接受 TAMG 胸腺切除术的 112 例患者的记录。采用多变量逻辑回归分析评估人口统计学、病理、术前数据和麻醉、手术细节,以预测胸腺切除术后长时间通气的风险。使用 R 软件构建预测术后通气概率的列线图。采用判别和校准评估列线图的性能。

结果

多因素分析显示,男性、肺活量低(VC)、Osserman 分类(IIb、III、IV)、全静脉麻醉和手术时间长是危险因素,并纳入列线图。列线图显示出强大的判别能力,受试者工作特征曲线(ROC)下面积为 0.835(95%置信区间 [CI],0.757-0.913)。校准图表明,列线图预测的概率与实际概率非常吻合(Hosmer-Lemeshow 检验:P=0.921)。

结论

该列线图是预测 TAMG 患者胸腺切除术后长时间通气的有价值的预测工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4140/8477565/cec13a390a42/13019_2021_1668_Fig1_HTML.jpg

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