Department of Nursing, TEDA International Cardiovascular Hospital, 61, Third Avence, TEDA, Tianjin, 300457, China.
Center for Basic Medical Research & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Sci Rep. 2022 Jun 30;12(1):11103. doi: 10.1038/s41598-022-15145-2.
The purpose of this study is to evaluate the relationship between preoperative physical performance (grip strength, gait speed, timed up and go) and postoperative pulmonary complications (PPCs) in patients who have undergone coronary artery bypass grafting (CABG). From September 2019 to August 2021, a total of 497 CABG patients who met the inclusion criteria of this study were examined for grip strength, 4-m gait speed, and timed up and go (TUG) before CABG surgery. Among them, 438 were included in the final analysis. PPCs were classified according to the operational definition of Kroenke et al. and patients with clinically significant PPCs were included in the data analysis. Logistic regression was utilised to analyse the relationship between physical performance and clinically significant PPCs. Besides, the receiver operating characteristic (ROC) curve was applied to analyse the predictive effect of grip strength, gait speed, and TUG on clinically significant PPCs after the CABG procedure. In total, 103 (23.5%) patients developed clinically significant PPCs after CABG. After making adjustments for the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and confounding factors, we established that low grip/weight (OR 0.510; 95% CI 0.363-0.715), slow gait speed (OR 0.619; 95% CI 0.517-0.741), and prolonged TUG (OR 1.617; 95% CI 1.379-1.895) were all independently correlated with clinically significant PPCs after CABG. The ROC curve analysis indicated that the area under the ROC curve of the integrated model of the three indicators (AUC 0.792 vs. 0.682, 0.754, 0.765) was larger than that of the model with a single indicator. Besides the predictive effect of the integrated model was superior to the models using grip/weight, gait speed, or TUG alone. Physical performance, including grip/weight, gait speed, and TUG, is a predictive factor for PPCs in CABG patients, and can be used in preoperative evaluations to and help improve the management of high-risk patients.
本研究旨在评估术前身体表现（握力、步态速度、计时起立行走）与接受冠状动脉旁路移植术（CABG）的患者术后肺部并发症（PPC）之间的关系。2019 年 9 月至 2021 年 8 月，对符合本研究纳入标准的 497 例 CABG 患者进行握力、4 米步态速度和计时起立行走（TUG）检查。其中，438 例患者纳入最终分析。根据 Kroenke 等人的操作定义对 PPC 进行分类，并将有临床意义的 PPC 患者纳入数据分析。采用 logistic 回归分析身体表现与有临床意义的 PPC 之间的关系。此外，还应用受试者工作特征（ROC）曲线分析 CABG 术后握力、步态速度和 TUG 对有临床意义的 PPC 的预测作用。总共有 103 例（23.5%）患者在 CABG 后出现有临床意义的 PPC。在调整欧洲心脏手术风险评估系统（EuroSCORE）和混杂因素后，我们发现握力/体重较低（OR 0.510；95%CI 0.363-0.715）、步态速度较慢（OR 0.619；95%CI 0.517-0.741）和 TUG 延长（OR 1.617；95%CI 1.379-1.895）与 CABG 后有临床意义的 PPC 均独立相关。ROC 曲线分析表明，三个指标综合模型的 ROC 曲线下面积（AUC 0.792 与 0.682、0.754、0.765 相比）大于单一指标模型。此外，综合模型的预测效果优于单独使用握力/体重、步态速度或 TUG 的模型。包括握力/体重、步态速度和 TUG 在内的身体表现是 CABG 患者 PPC 的预测因素，可用于术前评估并有助于改善高危患者的管理。
