慢性阻塞性肺病表型在住院选择性手术中的预测有效性:基于人口的研究
Ashwin Sankar1, Julian F Daza2, Joseph S Munn3
1Department of Anesthesia, St. Michael's Hospital - Unity Health Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
British journal of anaesthesia
|August 1, 2025
概括
慢性阻塞性肺病 (COPD) 现型显著影响手术患者的存活率. 基于表型的评估改善了手术前风险分层,以获得更好的患者结果.
科学领域:
- 肺部医学 肺部医学
- 手术结果研究研究.
- 流行病学 流行病学
背景情况:
- 慢性阻塞性肺病 (COPD) 在手术患者中很常见,但缺乏手术前评估指南.
- 不同的COPD表型对术后结果的影响尚不清楚.
研究的目的:
- 为了调查特定的COPD表型是否预测选择性手术后的存活率.
- 评估COPD表型在增强外科手术期间风险分层方面的有用性.
主要方法:
- 在加拿大安大略省,对116,000多名患有慢性肺炎的老年人 (≥65岁) 进行了回顾性队列研究,这些老年人接受了加拿大安大略省的选择性住院手术.
- 预先定义的COPD表型的分析,包括晚期COPD,虚弱,频繁恶化,心血管并发症,喘-COPD重叠和单独的COPD.
- 嵌套的考克斯比例危险模型评估了COPD表型对1年术后生存的基线风险模型的预测附加值.
主要成果:
- 当COPD表型被添加到基线模型时,COPD表型显著改变了生存预测.
- 晚期COPD和具有脆弱性的COPD与显著降低的存活率有关 (aHR分别为5.59和3.56).
- 与单独使用COPD相比,COPD与频繁恶化和心血管并发症的生存率略有下降 (aHR分别为1.45和1.35).
结论:
- 慢性肺炎的表型是术后生存的重要预测因素.
- 将COPD表型纳入术前评估,可以改善外科手术患者的术后风险分层.
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