在肺癌手术中进行术前评估的VE/VCO斜率值优化:确定真正的高风险和低风险群体
Karolina Kristenson1, Johan Hylander2, Miklos Boros1
1Department of Cardiothoracic and Vascular Surgery, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
使用VE/VCO2斜率的心肺运动测试 (CPET) 可以预测肺癌手术并发症. 基于VE/VCO2斜率的三层风险模型与传统方法相比,提高了风险预测的准确性.
科学领域:
- 心肺血管生理学 心肺血管生理学
- 胸部外科手术 胸部外科手术
- 在瘤学瘤学.
背景情况:
- 心肺运动测试 (CPET) 测量VE/VCO2斜率,这是已知的不良结果的预测指标.
- 目前的VE/VCO2斜率值是基于心力衰竭数据,这可能会限制它们在其他患者群体中的适用性.
研究的目的:
- 为了评估VE/VCO2斜率在分层化风险的主要肺部并发症 (MPC) 或肺癌手术后死亡的有效性.
- 用传统的单一门来比较风险分层,与基于灵敏度和特异性的新三风险组模型进行比较.
主要方法:
- 对158名肺癌患者进行回顾性分析,这些患者接受了叶切除术或肺切除术 (2008-2020年).
- 患者被分类使用传统的值 (VE/VCO2斜率=35) 和一种新的方法,有两个值 (<30对于90%的灵敏度,>41对于90%的特异性).
- 用曲线下的面积 (AUC),灵敏度,特异性,正预测值 (PPV) 和负预测值 (NPV) 来评估模型性能.
主要成果:
- 三个风险组模型 (低:30,中等:30-41,高:>41) 显示出明显不同的并发症率 (5%,16%,47%,P<0.001).
- 与单值方法相比,该模型改善了整体模型质量 (AUC 0.70).
- 高灵敏度值 (<30) 产生了95%的NPV,而高特异性值 (>41) 则具有47%的PPV.
结论:
- 使用基于手术前VE/VCO2斜率的三组风险分层比传统的两组方法更具歧视性.
- 拟议的三层模型提高了肺癌手术中术后并发症的预测准确性 (PPV和NPV).
- VE/VCO2斜率为优化肺癌切除患者的风险评估提供了一个有价值的工具.
更多相关视频
07:09Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise
Published on: February 20, 2017
08:25Combining Volumetric Capnography And Barometric Plethysmography To Measure The Lung Structure-function Relationship
Published on: January 8, 2019
相关概念视频
Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
Mechanical Ventilation I: Indication and Settings
Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
