通气效率和静息潮气末二氧化碳分压对肺癌切除术后心肺并发症的预测价值

Predictive value of ventilation efficiency and partial pressure of carbon dioxide at the end of resting moisture in cardiopulmonary complications after lung cancer resection

目的分析每分钟通气量与二氧化碳输出量(V_(E)/VCO_(2))斜率和静息潮气末二氧化碳分压(PetCO_(2))对肺癌切除术后心肺并发症的预测价值。方法收集2020年3月至2023年11月期间201例接受肺切除手术的早期非小细胞肺癌患者。所有患者术前均进行肺功能检查、心肺运动试验。随访记录患者术后30 d内的术后心肺并发症、重症监护病房(ICU)住院时间(LOS)、医院LOS、ICU再次入住率和死亡率。结果共有32例患者发生术后心肺并发症,纳入并发症组,其余患者纳入无并发症组(n=169)。并发症组患者的医院LOS、ICU LOS、ICU再次入住率均高于无并发症组(P<0.05)。与无并发症组相比,并发症组静息PetCO_(2)、V_(E)/VCO_(2)斜率显著升高(P<0.05)。经单因素及多因素Logistics分析,静息PetCO_(2)、V_(E)/VCO_(2)斜率为肺癌切除术后发生心肺并发症的独立影响因素(P<0.05)。静息PetCO_(2)预测肺癌切除术后发生心肺并发症的受试者工作特征曲线下面积为0.810(95%CI:0.741~0.880),与VE/VCO_(2)斜率[0.795(95%CI:0.720~0.871)]无显著差异。经Spearman秩相关分析及多元线性回归校正,静息PetCO_(2)与ICU LOS(r=-0.295,P<0.001)、医院LOS((V-0.271,P<0.001)呈负相关;VE/VCO_(2)斜率与ICU LOS(r=0.314,P<0.001)、医院LOS(r=0.301,P<0.001)呈正相关。结论静息PetCO_(2)和V_(E)/VCO_(2)斜率预测肺癌切除术后心肺并发症效能相似,这表明静息PetCO_(2)可以作为不能或不愿意接受CPET的患者的V_(E)/VCO_(2)斜率替代品。

Objective To analyze the value of the slope of VE/VCO_(2)per minute and the partial pressure of end-tidal carbon dioxide(PetCO_(2))in predicting cardiopulmonary complications after lung cancer resection.Methods 201 patients with early-stage non-small cell lung cancer who underwent lung resection between March 2020 and November 2023 were collected.All patients underwent pulmonary function examination and cardiopulmonary exercise test before operation.Postoperative cardiopulmonary complications,length of stay(LOS)in the intensive care unit(ICU),hospital LOS,ICU re-admission rate,and mortality were recorded within 30 days after surgery.Results A total of 32 patients with postoperative cardiopulmonary complications were included in the complication group,and the other patients were included in the non-complication group(n=169).The hospital LOS,ICU LOS and ICU re-occupancy rates in the complication group were higher than those in the non-complication group(P<0.05).Compared with the non-complication group,the resting PetCO_(2)and VE/VCO_(2)slopes of the complication group were significantly increased(P<0.05).Through univariate and multifactorial Logistics analysis,resting PetCO_(2)and VE/VCO_(2)slope were independent influencing factors for the occurrence of cardiopulmonary complications after lung cancer resection(P<0.05).The area under the working characteristic curve of resting PetCO_(2)for predicting cardiopulmonary complications after lung cancer resection was 0.810(95%CI:0.741-0.880),which was not significantly different from the VE/VCO_(2)slope[0.795(95%CI:0.720-0.871)].After Spearman rank correlation analysis and multiple linear regression correction,resting PetCO_(2)was negatively correlated with ICU LOS(P<0.001)and hospital LOS(P<0.001).VE/VCO_(2)slope was positively correlated with ICU LOS(P<0.001)and hospital LOS(P<0.001).Conclusion The efficacy of resting PetCO_(2)and VE/VCO_(2)slope in predicting cardiopulmonary complications after lung cancer resection is similar,suggesting that resting PetCO_(2)can be used as a substitute for VE/VCO_(2)slope in patients who are unable or unwilling to receive CPET.