肺癌患者手术后肺部并发症发生的良好预测指标分析

Good indicators to predict postoperative pulmonary complications occurred in patients with lung cancer

目的探讨肺癌患者手术前肺功能指标对肺切除术后肺部并发症的预测能力。方法收集698例进行开胸肺切除手术患者术前肺功能检查的详细资料,回顾性分析常规肺功能检查指标与术后肺部并发症(PPC)的关系。结果在698例手术治疗的肺癌患者中,有86例(12.3%)患者术后发生肺部并发症(PPC)。PPC组与无PPC组中第一秒用力呼气容积(FEV1)、第一秒用力呼气容积占预计值百分比(FEV1%)、最大分钟通气量(MVV)、最大分钟通气量占预计值百分比(MVV%)、一次呼吸法测定肺一氧化碳弥散量(TLCOSB)、肺一氧化碳弥散量占预计值百分比(TLCOSB%)、肺泡一氧化碳弥散量占预计值百分比(TLCOVA%)、PpoFEV1和PpoFEV1%指标经t检验差异有统计学意义(P<0.05);而FVC和TLCOVA指标差异无统计学意义(P>0.05)。将698例患者分别根据通气和弥散功能障碍分组,PPC的发生率在FEV1%<70%、PpoFEV1%<40%和TLCOSB%<60%组明显升高,各组间差异有统计学意义(P<0.05);而不同PpoFEV1组间差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,FEV1%(OR=0.868,P<0.05)和TLCOSB%(OR=0.937,P<0.05)是预测术后PPC的独立保护因素,手术时间(OR=1.021,P<0.05)是预测术后PPC的独立危险因素。结论术前肺功能可以预测肺癌患者肺切除术后肺部并发症的发生,FEV1%和TLCOSB%是预测肺部并发症发生的良好指标。

Objective The aim of this study was to investigate the value of preoperative pulmonary function in predicting postoperative pulmonary complications （PPC） after lung resection in lung cancer patients. Methods Six hundred and ninety-eight lung cancer patients receiving lung resection, with details of pulmonary function tests （PFF） , were enrolled in this study. The relationship between PPC and the parameters of PFT was retrospectively analyzed. The Pvalue less than 0. 05 was considered as statistically significant. Results The morbidity rate of PPC was 12. 3% （86/698）. The patients were stratified into groups based on FEVI% （≥70%, 〈 70% ）, PpoFEV1 （ ≥ 1.4L, 1.0-1.4, 〈 1.0L）, PpoFEVI% （≥40%, 〈40% ） and TLCOSB% （≥60%, 〈 60% ）. There were statistically significant differences among these groups in the parameters（ P 〈 0. 05 ）, the rates of PPC were much higher in the groups with poor pulmonary function（ FEV1% 〈 70%, PpoFEV1% 〈 40% or TLCOSB% 〈 60% ）. There was no statistically significant difference among PpoFEV1 groups （ P 〉 0. 05 ）. It was shown by logistic regression analysis that PPC were significantly correlated to FEV1% （ OR = 0. 868, P 〈 0.05 ） and TLCOSB% （ OR = 0. 937, P 〈 0. 05 ）. Conclusions Preoperative pulmonary function could assess the rates of PPC in lung cancer patients after lung resection. The parameters of FEVI% and TLCOSB% were potential indicators.