肺通气功能检查在评价心脏外科手术预后中的价值

Value of Pulmonary Ventilation Function Test in Evaluating the Prognosis of Cardiac Surgery

目的研究术前肺通气功能在评价心脏外科手术预后中的价值。方法采用回顾性分析的方法,选择2007年1月至2008年12月在复旦大学附属中山医院心脏外科住院的冠心病和心瓣膜病患者。分析未施行手术的情况及术后不良预后指标:术后院内死亡、人工气道时间延长(≥3 d)或ICU停留时间延长(≥5 d)与肺通气功能分级的关系。结果共入选422例,通气功能障碍发生率55.0%,其中限制性27.5%,阻塞性15.6%,混合性11.8%。肺功能障碍分级:轻度34.6%,中度15.2%,重度5.2%。完成术前检查而放弃手术的42例患者中,源于肺功能障碍50.0%。在轻度、中度和重度障碍组中,未手术的比例分别为1.4%、15.6%和40.9%(P<0.001)。手术患者中住院死亡率3.1%,人工气道时间延长8.2%,ICU停留时间延长11.2%,术后预后不良12.1%,不同肺功能组间差异无统计学意义(P>0.05)。多因素Logistic回归分析显示体外循环是术后不良预后的独立危险因素,而限制性肺功能障碍患者术后不良预后的发生率低(P<0.05)。结论心脏外科患者术前肺功能障碍的发生率高。重度肺功能障碍是放弃手术的重要因素,但可能不是手术的绝对禁忌证。

Objective To assess the value of pulmonary ventilation test in evaluating the prognosis of cardiac surgery patients.Methods Data were collected retrospectively from consecutive patients with coronary heart disease or valvular disease,who were prepared for cardiac surgery in Zhongshan Hospital from January 2007 to December 2008.The main outcome indices were mortality of surgery,the prolonging time of using artificial airway(≥3 days),and the prolonging time in intensive care units(ICU)(≥5 days).Then the relationship between the poor outcome and ventilation disorder was analyzed.Results In the 422 cases,the incidence of ventilation disorder was 55%,included 27.5% restrictive ventilation disorder,15.6% obstructive ventilation disorder,and 11.8% mixed ventilation disorder.And the severity of pulmonary ventilation disorder was mild of 34.6%,moderate of 15.2%,and severe of 5.2%.Among the 42 patients who gave up surgery,50% were due to ventilation dysfunction,and the patients were prone to give up surgery with the deterioration of pulmonary function(P<0.001).But comparing with the patients with normal pulmonary function,the risk of poor outcome after surgery did not significantly increase in the patients with ventilation disorder(P>0.05).The logistic regression analysis indicated that cardiopulmonary bypass(CPB) was an absolute risk factor(P<0.05).Conclusions The incidence of ventilation disorder in patients with cardiac disease is quite high.Severe pulmonary ventilation disorder is the significant cause of giving up surgery,but may be not the absolute contraindication of cardiac surgery.