强迫振荡肺功能预测肺切除术后呼吸衰竭的临床价值

Clinical study on forced oscillatory pulmonary function test predicting respiratory failure after pulmonary resection

目的分析术前肺功能及强迫振荡肺功能(FOT)检查在预测术后呼衰中的临床价值。方法对473例肺切除患者术前除常规肺功能检查外均进行强迫振荡肺功能检测,以术后是否发生呼衰分为两个观察组,对患者详细资料的34个项目观察分析,观察数据进行统计学处理。用logistic回归分析筛选出导致术后呼衰的术前危险因素,并对其参数估计值进行标准化处理,以评价FOT在预测术后呼衰的临床价值。结果34个观察项目中,有21项提示与术后呼衰有密切关系。根据二项logistic回归筛选,只有8个因素作为术后呼衰的危险因素被筛选出。FOT检查中的5 Hz时的阻抗＼即弹性阻力(X_5)预测呼衰的灵敏度、特异度及准确率与第1秒用力呼气量(FEV1)相接近,而20 Hz时的黏性阻力占预计值百分比(R_(20)%)与最大通气量的实测值占预计值百分比(MVV%)相接近。结论强迫振荡肺功能(FOT)检查在预测术后呼衰方面与常规肺通气功能一样具有同等重要地位,甚至优于部分传统指标。

Objective To study the clinical value of routine pulmonary function test and forced oscillatory pulmonary function test （For） in predicting respiratory failure after pulmonary resection. Methods 473 patients were operated after routine pulmonary function test and forced oscillatory pulmonary function test （FOT）. And divided tow groups whether or not occurring respiratory failure after pulmonary resection. We analyzed 34 factors about these patients and filtrated the factors that induce respiratory failure by Logistic regression. Results In 34 observations items, 21 factors are related to respiratory failure after pulmonary resection. According to screens by Logistic regression, 8 factors were screened as the dangerous factors after pulmonary resection. The patient has the dangerous factor are more, after the surgery the breath failure formation rate is higher. Xs in the FOr forecasts the sensitivity, the peculiarity and accurate rate is similar with FEV1. and R20 % similar with MVV %. Conclusion FOT and the conventional lung function is equally important in prediction respiratory failure after pulmonary resection. Even is more even better than the partial traditional target.