常规肺功能检查与运动心肺功能检查在预测高危胸部肿瘤患者术后心肺并发症中的作用

Role of conventional pulmonary function tests and cardiopulmonary exercise test in the prediction of postoperative cardiopulmonary compfications in high risk thoracic cancer patients

目的比较常规肺功能与运动心肺功能检查在预测高危胸部肿瘤患者不同术式治疗后心肺并发症方面的价值。方法2006年1月至2009年1月间连续收治的216例胸部肿瘤患者中接受手术治疗的患者159例，收集其常规肺通气功能检查、运动心肺功能检查及临床资料，回顾性分析常规肺通气功能检查、运动心肺功能检查指标与术后心肺并发症的关系。结果159例手术治疗的患者中，有36例（22．6％）患者术后发生心肺并发症共44例次，10例（6．3％）患者发生手术相关并发症，3例（1．9％）患者围手术期死亡。将159例手术治疗的患者，分别根据V02max／pred的检测值分为≥65．0％组和〈65．0％组，根据V0．max·kg^-1·min。的检测值分为≥20．0ml组、15．0～19．9ml组和〈15．0ml组，根据FEVl的检测值分为≥2．00L组、1．20—1．99L组和〈1．20L组，心肺并发症发生率在V0，max／pred〈65．0％组、V02max·kg^-1·min。〈15．0ml组和FEV1〈1．2L组略有升高，但各组间差异多无统计学意义。多因素Logistic回归分析显示，患者的伴随疾病（OR=1．824，P=0．028）、综合肺通气功能状况（OR=1．832，P=0．008）、手术方式（OR=2．227，P=0．026）、手术相关并发症（OR=42．574，P：0．001）是术后心肺并发症发生的独立影响因素，患者综合肺通气功能状况（OR=2．565，P：0．047）、V0，max／pred（OR=0．020，P=0．004）、V0，max·kg^-1·min^-1（OR=8．809，P=0．013）和手术相关并发症（OR=107．517，P〈0．001）是术后呼吸功能衰竭发生的独立影响因素。结论常规肺功能中的FEVl、运动心肺功能中的V。max／wed和V02nlax·kg^-1·min^-1指标可将患者的心肺功能状况分层，但以V0，max·kg^-1·min^-1为最优，且与FEVl相关性较好。V02．max·kg^-1·min^-1与术后心肺并发症发生有关。

Objective To evaluate and compare the value of cardiopulmonary exercise test and conventional pulmonary funetion tests in the prediction of postoperative cardiopulmonary complications in high risk patients with chest malignant tumors. Methods From January 2006 to January 2009, 216 consecutive patients with thoraeic malignant tumors underwent conventional pulmonary function tests （PFT, spirometry ＋ DLCOsb for diffusion capacity） and cardiopulmonary exercise test （CPET） preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET were retrospectively analyzed using Chi-square test, independent sample t-test and logistic regression analysis. The P value 〈 0.05 was considered as statistically significant. Results Of the 216 patients, 57 did not receive operation due to advanced stage diseases or poor cardiopulmonary funetion in most of them. The remaining 159 underwent different modes of operations. Thirty-six patients （22.6%） in this operated group had postoperative cardiopulmonary complications and 10 patients （6. 3% ） developed operation-related complications. Three patients （ 1.9% ） died of the complications within 30 days postoperatively. The patients were stratified into groups based on Vo2max/pred （ ≥65.0%, 〈65.0% ） ; Vo2max ·kg^-1·min^-1 （≥20 m1,15-19.9 ml, 〈15 ml） and FEV1 （ ≥2.0 L, 1.2-1.99 L, 〈1.2 L） according to the criteria in reported papers. There was statistically significant difference among these groups in the parameters （P 〈 0.05 ） , the rates of postoperative cardiopulmonary complications were much higher in the groups with poor cardiopulmonary function （ Vo2max/pred 〈65.0% ; Vo2max ·kg^-1·min^-1 〈 15 ml or FEV1 〈 1.2 L）. It was shown by logistic regression analysis that postoperative cardiopulmonary complications were significantly correlated with age, associated diseases, poor results of PFT or CPET, operation modes and operation-related complications. Conclusions FEV1 in spirometry, Vo2 max·kg^-1·min-1 and Vo2 max/pred in cardiopulmonary exercise test can be used to stratify the patients＇ cardiopulmonary function status and is correlated well with FEV1. Vo2 max·kg^-1·min is the best parameter among these three parameters to predict the risk of postoperative cardiopulmonary complications in patients with chest malignant tumors and borderline cardiopulmonary function.