肺最大通气量实测值占预计值百分比在围术期中评估价值研究

Measured value and calculated value of maximal lung ventilation in the perioperative period

目的探讨肺最大通气量(MVV)实测值占预计值百分比(MVV%pred)在围术期的评估价值。方法选取61例行胸与上腹部手术后肺功能异常的患者,将50%≤MVV%pred<80%的患者纳入A组(33例),MVV%pred<50%的患者纳入B组(28例)。比较两组一秒用力呼气容积(FEV_1),用力肺活量(FVC),一氧化碳弥散量(DLco),5 Hz时呼吸阻力(R_5),MVV,残气量(RV),肺总量(TLC)及术后并发症发生概率。采用两种方法计算MVV估算值:方法一公式为MVV%pred=FEV_1×35/MVV预计值,方法二公式为MVV%pred=FEV_1×33+9/MVV预计值。结果与A组比较,B组FEV_1、MVV、FVC降低,R_5、RV、TLC升高,差异有统计学意义(P<0.05);两组DLco差异无统计学意义(P>0.05)。3种方法获得的MVV值中,实测值与方法一公式计算获得的估算值差异无统计学意义(P>0.05),而与方法二公式计算获得的估算值差异有统计学意义(P<0.05);方法一与方法二公式计算获得的预测值差异也有统计学意义(P<0.05)。A组患者术后并发症发生率为6.1%(2/33),明显低于B组的39.3%(11/28),差异有统计学意义(P<0.05)。结论 MVV%pred<50%的患者的肺通气功能减退与RV、TLC、气道阻力增高的程度明显高于50%≤MVV%pred<80%的患者,但两者弥散功能损害差异不明显。对不能配合完成MVV测试获得MVV%pred实测值的患者,可用公式MVV=FEV_1×35/MVV预计值计算获得的估算值对手术适应证进行评估。

Objective To evaluate the value of the estimated percentage（ MVV% pred） of the maximum lung volume（ MVV） in the perioperative period. Methods A total of 61 cases of patients with thoracic and upper abdominal surgical lung dysfunction,patients whose MVV% pred greater than 50% and less than 80% were divided into Group A（ n = 33）,the others whose MVV% pred less than50% were in Group B（ n = 28）. The forced expiratory volume in one second（ FEV1）,the forced vital capacity（ FVC）,the amount of carbon monoxide dispersion（ DLco）,5 Hz airway resistance（ R5）,MVV,residual volume（ RV）,lung volumes（ TLC） and the incidence of postoperative complications of the two groups were compared. Method One： MVV% pred = FEV1× 35/MVV,Method Two： MVV%pred = FEV1× 33 ＋ 9/MVV. Results Compared with Group A,FEV1,MVV,FVC reduced,R5,RV,TLC increased in Group B（ P 〈0. 05）; the DLco of the two groups had no statistical significance（ P 〉 0. 05）. Three methods for MVV % pred,measured values and the Method One has no statistically significant difference（ P 〉 0. 05）,and has statistically significant difference with Method Two（ P 〈0. 05）. The postoperative complication in Group A（ 6. 1%,2/33） was significantly lower than that in Group B（ 39. 3%,11/28）,and the difference had statistical significance（ P 〈 0. 05）. Conclusion MVV% pred measured volume measured value is expected to account for a percentage value which is less than 50%,pulmonary hypofunction,the increased RV and TLC is significantly higher than that of MVV% pred greater than 50% and less than 80% of the patients,the diffusion function damage of the two groups are the same; MVV calculation method and calculation method in MVV value is a result of difference,while MVV measured value and calculation method in MVV value is identical to the results,of COPD history and not with MVV tests completed patients,MVV% pred =FEV1× 35/MVV calculation method of surgical indications evaluation has the same meaning.