肺癌全肺切除术后早期右心功能不全的危险因素分析

Features and risk factors analysis of early postoperative on right ventricular dysfunction in pneumonectomy for lung cancer

目的探讨肺癌患者全肺切除术后早期右心功能不全(RVD)的发生及其影响因素。方法回顾性分析南京医科大学第一附属医院胸心外科2007年3月至2010年9月间97例行全肺切除术肺癌患者的资料,根据术后右心肌机能指数(Tei指数)分为RVD组(Tei>0.28)和正常组(Tei≤0.28),对影响RVD的因素进行单因素和多因素分析。结果 97例全肺切除术后患者住院期间无死亡,RVD发生率为16.5%。单因素分析显示,RVD组与正常组在年龄、FEV1/FVC、术前ECG、术前肺动脉压力、肺功能、右肺切除、术中液入量这些因素的差异均有统计学意义(P<0.05)。Logistic多因素分析显示,年龄(OR=12.68,P<0.01)、术前肺动脉压力(OR=8.31,P<0.05)、术中液入量(OR=15.74,P<0.01)与RVD的发生明显相关。结论 RVD是全肺切除术后严重的并发症,年龄>70岁、术前肺动脉高压、术中液入量正平衡是手术后早期RVD发生的危险因素。

Objective To analyze the features and risk factors of early postoperative on right ventricular dysfunction （RVD） in pneumonectomy for lung cancer. Methods A total of 97 lung cancer patients who received pneumonectomy from March 2007 to September 2010 were included in the study. The patients were assigned into RVD group（ Tei 〉 0. 28 ）and normal group（ Tei ~〈0. 28 ） , and postoperative factors were collected and analyzed between two groups, and the multivariate analysis（ Logistic regression） were use to identify the risk factors of RVD. Results No one died during hospitalization. The incidence rate of RVD was 16. 5% （ 16/97 ）. Univariate analysis revealed that there were significant differences in age, FEV1/FVC, preoperative arrhythmias, preoperative pulmo- nary function, pulmonary hypertension, right pneumonectomy and volume overload between two groups （ P 〈 0. 05 ）. Three variables were found to be significantly related to the development of RVD by multivariate analysis： age（ OR = 12. 68 ,P 〈0. 01 ）, pulmonary hy- pertension （ OR = 8.31, P 〈 0. 05 ） , volume overload （ OR = 15.74, P 〈 0. 01 ）. Conclusion RVD is a serious complication after pneu- monectomy. Factors such as age 〉 70 years, pulmonary hypertension and volume overload are associated with RVD.