肺切除手术前进行心肺运动测试:仍然适用吗? 使用机器学习评估预测效用
Ákos Filakovszky1, Kristian Brat2,3, Thomas Tschoellitsch1
1Department of Anesthesiology and Critical Care Medicine, Johannes Kepler University and Kepler University Hospital, Linz, Austria.
Thorax
|October 3, 2025
概括
心肺运动测试 (CPET) 不能改善肺切除候选人的术后并发症预测. 根据这些发现,CPET对肺部外科手术风险分层的当前指导方针可能需要重新评估.
科学领域:
- 肺部医学 肺部医学
- 胸部外科手术 胸部外科手术
- 心脏病学 心脏病学
背景情况:
- 肺切除风险分层的心肺运动测试 (CPET) 标准已经有十多年的历史了.
- 患者护理的进步需要更新的风险评估工具.
- 假设:CPET对术后并发症没有额外的预测价值.
研究的目的:
- 评估CPET在肺切除风险分层中的附加预测价值.
- 评估CPET是否能提高机器学习模型在预测术后并发症方面的性能.
主要方法:
- 两项前性多中心研究的二次分析.
- 包括通过CPET,肺功能测试 (PFT) 和动脉血液气体分析评估的肺切除候选人.
- 使用嵌套交叉验证,训练机器学习模型来预测肺部和心血管并发症.
主要成果:
- 包括497名患者;14%的人患有肺部并发症 (PPC) 和18%的人患有心血管并发症 (PCC).
- CPET参数没有提高机器学习模型对未被选择或指南选择的子组的PPC或PCC的预测准确度.
- 接收器运行特征曲线 (AUC-ROC) 下的面积在CPET纳入后没有显著改善.
结论:
- 在当代外科实践中,CPET并没有提高PPC或PCC的机器学习模型的预测性能.
- 在肺切除术前风险分层中CPET的实用性需要重新评估.
- 目前关于CPET在肺切除中的使用指南可能需要更新.
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