Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial
Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial
复制标题
DOI：
10.1016/j.jtcvs.2005.09.006
复制
发表时间：
2006-01-01
影响因子：
6
通讯作者：
Deschamps, C
中科院分区：
文献类型：
--
作者：
Naunheim, KS;Wood, DE;Deschamps, C
目的：我们试图找出肺减容术后手术死亡率、肺部发病率和心血管发病率的预测因素。方法：进行单因素和多因素logistic回归分析。候选预测因素包括人口统计学特征。身体状况特征、肺功能测量、由放射科医师和通过胸部计算机断层扫描的计算机分析确定的肺气肿分布测量、以及运动能力、呼吸困难和生活质量测量。分析的终点是手术死亡率（手术后90天内死亡），主要肺部疾病（气管造口术，脱机失败，重新插管，肺炎，呼吸机>= 3天），心血管疾病（梗死，肺栓塞，或心律失常需要治疗）。手术死亡率为5.5%，29.8%的患者发生严重肺部疾病，20.0%的患者发生心血管疾病。这些终点的预测因素如下：[图形]结论：虽然肺减容术可以在选定的患者中进行，死亡率可接受，但主要心肺疾病的发生率仍然很高。肺减容手术死亡率的唯一预测因素是由放射科医师评估的非上叶为主的肺气肿。一氧化碳弥散量和1秒用力呼气量较低的老年患者可能会出现肺部疾病。在评估发病率时，计算机辅助胸部计算机断层扫描分析仅在预测心血管并发症方面有用。
Objective: We sought to identify predictors of operative mortality, pulmonary morbidity, and cardiovascular morbidity after lung volume reduction surgery.Methods: Univariate and multivariate logistic regression analyses were performed. Candidate predictors included demographic characteristics. physical condition characteristics, pulmonary function measures, measures of the distribution of emphysema as determined by radiologists and by means of computerized analysis of chest computed tomographic scans, and measures of exercise capacity, dyspnea, and quality of life. End points analyzed were operative mortality (death within 90 days of the operation), major pulmonary morbidities (tracheostomy, failure to wean, reintubation, pneumonia, and ventilator for >= 3 days), and cardiovascular morbidities (infarction, pulmonary embolus, or arrhythmia requiring treatment).Results: Five hundred eleven patients in the non-high-risk group of the National Emphysema Treatment Trial underwent lung volume reduction. The incidence of operative mortality was 5.5%, major pulmonary morbidity occurred in 29.8% of patients, and cardiovascular morbidity occurred in 20.0% of patients. Predictors for these end points are as follows:[GRAPHICS]Conclusions: Although lung volume reduction can be performed in selected patients with acceptable mortality, the incidence of major cardiopulmonary morbidity remains high. The lone predictor for operative mortality of lung volume reduction was the presence of non-upper-lobe-predominant emphysema, as assessed by the radiologist. Pulmonary morbidity can be expected in elderly patients who have a low diffusing capacity for carbon monoxide and forced expiratory volume in 1 second. When assessing, morbidity, the computer-assisted chest computed tomographic analysis proved useful only in predicting cardiovascular complications.