术前呼气峰流速对肺癌患者肺叶切除术后肺部并发症预测价值的研究

The preoperative peak expiratory flow for predicting postoperative pulmonary complications after lobectomy for lung cancer patients

目的探索肺癌患者肺叶切除术前呼吸峰流速(PEF)对术后肺部相关并发症(PPC)的临床预测价值。方法纳入就诊于本院的150例肺癌患者,所有患者均接受肺叶切除术,根据术后是否出现PPC分为PPC组(29例)和无PPC组(121例)。采集2组患者一般临床信息、PEF和PPC等数据并进行统计分析,Logistic回归分析影响患者发生PPC的危险因素,受试者工作特征(ROC)曲线评价PEF对PPC的预测价值。结果与无PPC组患者相比,PPC组合并COPD患者比例升高,PEF下降,住院时间延长(P<0.01),Logistic回归分析结果显示,有COPD病史(OR=2.017,95%CI:1.655~5.037)是肺叶切除术后PPC发生的独立危险因素,而PEF升高(OR=0.585,95%CI:0.255~0.793)为PPC发生的保护因素。PEF预测PPC的ROC曲线下面积为0.773(95%CI:0.742~0.803),最佳临界值为297 L/min(敏感度68.6%、特异度79.2%)。结论低PEF值与肺癌患者肺叶切除术后PPC的发生有关,是PPC的独立预测因子。

Objective To investigate the value of peak expiratory flow(PEF)in the prediction of postoperative pulmonary complications(PPC)for lung cancer patients undergoing lobectomy.Methods A total of 150 lung cancer patients admitted to our hospital were included in this study.All patients underwent lobectomy.According to whether PPC occurred or not after surgery,the patients were divided into PPC group(n=29)and no PPC group(n=121).Data of general clinical information,PEF and PPC were collected for further analysis.The risk factors of PPC were analyzed by logistic regression analysis,and the predictive value of PEF on PPC was evaluated by ROC curve.Results Compared with the patients without PPC,there was an increased proportion of patients with COPD,decreased PEF,and prolonged length of hospital stay in PPC patients(P<0.01).Logistic regression analysis showed that the history of COPD(OR=2.017,95%CI:1.655-5.037)was an independent risk factor for PPC after lobectomy,and increased PEF(OR=0.585,95%CI:0.255-0.793)was a protective factor for PPC.The area under ROC curve(AUC)of PPC predicted by PEF was 0.773(95%CI:0.742-0.803),and the best critical value was 297 L/min(sensitivity 68.6%,specificity 79.2%).Conclusion The lower PEF is significantly associated with the increased PPC in lung cancer patients receiving lobectomy.PEF is an useful tool in perioperative management of lung cancer candidates.