| Object:The incidence of postoperative pulmonary complications and risk factors were discussed by reviewing the case data of patients undergoing intracranial surgery in Nanfang hospital of southern medical university in recent 2 years.The risk prediction model of postoperative pulmonary complications after intracranial surgery was established to provide certain reference value for the prevention and reduction of postoperative pulmonary complications in clinical work.Methods:According to inclusion criteria:(1)age 18 or older;(2)intracranial surgery was performed in our hospital;(3)preoperative diagnosis of pulmonary diseases among the pulmonary complications defined in this study was not combined.Exclusion criteria:(1)patients who have undergone intracranial surgery within the past year;(2)patients undergoing other operations at the same time;(3)incomplete clinical case data.A retrospective analysis was performed on 945 patients who underwent intracranial surgery in Nanfang hospital of southern medical university from January 2016 to February 2018.The general situation of the patients and the risk factors related to postoperative pulmonary complications during perioperative period were recorded,and the occurrence of postoperative pulmonary complications was used as the main outcome observation index.The postoperative pulmonary complications covered included pneumonia,pleural effusion,atelectasis,pneumothorax,bronchitis,ARDS and bronchospasm.630 patients from January 2016 to October 2017 were used as modeling group.the risk prediction model of postoperative pulmonary complications was established by using their clinical data,and the prediction model was tested.The test effectiveness of the risk prediction model was judged according to the area under the receiver operating characteristic curve.From November 2017 to February 2018,315 patients were used as validation group to verify the risk prediction model and further judge the predictive ability of the model.Results:945 patients undergoing intracranial surgery were included in this study,137(14.5%)had postoperative pulmonary complications after intracranial surgery.There were 630 patients in the modeling group,ranging in age from 18 to 83 years,with an average age of(46.2 ± 13.6)years,including 294 male patients and 336 female patients.95 patients(15.1%)had postoperative pulmonary complications and ARDS(55 ≤95 and pneumonia(52 ≤95)were the most common.Postoperative pulmonary complications were most common in patients with hematoma clearance and other operations.Multivariate Logistic regression analysis showed that length of stay in ICU(OR 1.105,95%CI:1.009-1.210,P 0.032),duration of mechanical ventilation(OR 1.053,95%CI:1.022-1.086,P 0.001),history of smoking(OR 3.054,95%CI:1.448-6.444,P 0.003),preoperative infection(OR 2.691,95%CI:1.048-6.911,P 0.040)and indwelling gastric tube(OR 6.948,95%CI:3.477-13.884,P<0.001)were independent risk factors for postoperative pulmonary complications after intracranial surgery.According to the results of multivariate Logistic regression analysis,a model for predicting postoperative pulmonary complications after intracranial surgery was established.The AUROC was 0.808(95%CI:0.756-0.861).The sensitivity and specificity were 71.6%and 77.1%.According to the prediction model,the prediction value from 315 patients in the verification group were calculated and compared with the actual value,it was found that the sensitivity and specificity of the model were 76.2%and 93.0%.The total correct rate was 90.8%.Conclusion:Univariate analysis showed that the occurrence of PPCs was associated with length of stay in ICU,duration of mechanical ventilation,history of smoking,preoperative infection and indwelling gastric tube.The prediction model based on the independent risk factors of postoperative pulmonary complications can effectively predict the risk of postoperative pulmonary complications.However,more reliable results depend on further prospective studies of multicenter and large samples. |
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