常规肺功能检测联合登楼梯试验在预测非小细胞肺癌患者术后心肺并发症中的作用

Role of conventional pulmonary function tests and stair climbing test in the prediction of postoperative cardiopulmonary complications in non-small cell lung cancer patients after surgery

目的探讨常规肺功能检测联合登楼梯试验在预测非小细胞肺癌患者不同术式治疗后心肺并发症方面的应用价值。方法162例肺功能相对较差的非小细胞肺癌患者中，14例患者由于最终术前分期较晚或术前心肺功能较差不适合手术治疗，4例患者拒绝接受手术，1例患者行单纯探查术，最终143例患者入组，分别接受了不同术式的手术治疗。143例患者进行术前常规肺功能检测和登楼梯试验，并监测术后并发症的发生情况。分析术前常规肺功能检测和登楼梯试验检测结果与术后心肺并发症之间的关系。结果143例患者中，41例患者术后出现不同程度的心肺并发症，其发生率为28．7％。全组患者无术后30d内死亡。登5层楼梯（18．36m）时间（t）≥92s组、登楼梯过程中血氧饱和度下降程度（EOD）≥5％组、登楼梯时最大心率与平静时心率变化的差值（△P）〈550次/min组患者的术后心肺并发症发生率分别为38．5％、42．0％和35．1％，t〈92s组、EOD〈5％组和△P≥55b次/min组患者的术后心肺并发症发生率分别为16．9％、21．5％和18．2％，差异均有统计学意义（均P〈0．05）。Logistic回归分析结果显示，EOD和不满足肺功能术式标准，是术后心肺并发症的独立危险因素。结论登楼梯试验作为安全、简易、低成本的检测手段，能够较好地预测非小细胞肺癌患者术后心肺并发症的发生。常规肺功能检查联合登楼梯试验可推荐作为胸外科手术前常规检测手段。

Objective To evaluate and compare the value of stair climbing tests and conventional pulmonary function tests in the prediction of postoperative cardiopulmonary complications in non-small cell lung cancer patients underwent surgery. Methods From April 1, 2010 to Jan. 30,2012, a total of 162 patients with thoracic carcinoma underwent stair climbing test （SCT） and conventional pulmonary function tests （PFT） preoperatively. The correlation of postoperative cardiopulmonary complications with the SCT and PFT parameters were analyzed retrospectively using chi-square test, independent sample t test and binary logistic regression analysis. Results Of the 162 patients, 19 without operation were excluded, due to an advanced stage （9 cases）, poor cardiopulmonary function （5 cases）, rejecting operation （4 cases） and exploration alone （1 case）. 143 cases were eligible and evaluated eventually. Forty-one of the 143 patients （28.7%） had postoperative cardiopulmonary complications, but no death occurred. The patients were stratified into groups based on the time of stair climbing 5 stories （18.36 m, t, 〈92 s, 1〉92 s）. Exercise oxygen desaturation（EOD） during the stair climbing test （ 〈 5%, 〉/5% ） and the difference between the pulse at resting state and the pulse at end of stair climbing test （AP, 〈 55 beats/min, I〉55 beats/rain）, respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the groupwith t I〉92 s, EOD≥5% and △P 〈55 beats/min （38.5%, 42.0% and 35.1%, respectively） than that in the group with t 〈92 s, EOD 〈5% and △P≥55 beats/rain （16.9%, 21.5% and 18.2%, respectively）. Binary logistic regression analysis showed that postoperative cardiopulmonary complications were independently correlated with EOD and lung function which did not meet the requirement of the lung resection operation mode. Conclusions A symptom-limited stair climbing test is a safe, simple and low cost method to evaluate the cardiopulmonary function preoperatively. It can predict the occurrence of postoperative cardiopulmonary complications in non-small cell lung cancer patients. Conventional pulmonary function tests and stair-climbing test can be recommended to be routinely performed in all patients with non small cell lung cancer before thoracic surgery.