LAA%预测肺癌合并慢性阻塞性肺疾病患者肺叶切除术后心肺并发症的价值

Value of quantitative CT in predicting cardiopulmonary complications in patients with lung cancer complicated with chronic obstructive pulmonary disease after lung lobectomy

目的探讨肺癌合并慢性阻塞性肺疾病(COPD)患者肺叶切除术前CT检测低衰减区占肺野面积百分比(LAA%)与术后心肺并发症的关系。方法回顾性分析2013年3月—2018年6月在沧州市人民医院医专院区治疗的80例行肺叶切除术的肺癌合并COPD患者的临床资料,包括术前因素(包括定量CT检测LAA%)和术中因素。评估心肺并发症,包括脓胸、肺炎、肺不张、急性肺损伤、胸腔留置管、长时间供氧及心律失常。结果30例患者(37.5%)出现心肺并发症。单因素分析显示,患者年龄、失血量、第一秒用力呼气容积(FEV1)占用力肺活量(FVC)的比值(FEV1/FVC)、LAA%与心肺并发症有关(P<0.05)。多因素Logistic回归分析显示,年龄[OR=4.62(95%CI:2.03,10.49)]和LAA%[OR=5.58(95%CI:2.31,13.49)]是患者术后发生心肺并发症的重要独立预测因子。结论 LAA%可用于预测肺癌合并COPD患者行肺叶切除术后的心肺并发症。对年龄≥70岁且LAA%≥1.0%的患者,必须谨慎地进行术中和术后处理。

Objective To examined the relationship between the regional ratio of the emphysematous area in pre-operative computed tomography images and cardiopulmonary complications in patients with chronic obstructive pulmonary disease who underwent lung cancer resection.Methods We retrospectively evaluated 80 patients with chronic obstructive pulmonary disease who underwent lobectomy for lung cancer at our hospital.Pre-operative factors,including the proportion of the emphysematous area measured by computed tomography as a percentage of the low attenuation area(LAA%)and intraoperative factors,were analyzed.Cardiopulmonary complications,including pyothorax,pneumonia and atelectasis,acute pulmonary injury,indwelling chest tube,long duration of oxygen supply,and arrhythmia,were evaluated.Results Cardiopulmonary complications were observed among 30 patients(37.5%).Univariate analysis revealed that patient age(P<0.05),FEV1/FVC(P<0.05),LAA%(P<0.05),and volume of blood loss(P<0.05)were significantly associated with cardiopulmonary complications.Multivariate analysis indicated patientage[OR=4.62(95%CI:2.03,10.49)]and LAA%[OR=5.58(95%CI:2.31,13.49)]as being significant independent predictors of cardiopulmonary complications.Conclusion The regional ratio of the emphysematous area is useful for predicting cardiopulmonary complications in patients with chronic obstructive pulmonary disease who undergo lobectomy for lung cancer.For patients who are≥70 years and with LAA%≥1.0%,careful intra-and post-operative management is warranted.