心肺运动试验(CPET)精准预测功能状态良好的肺切除手术患者的术后并发症风险

Cardiopulmonary exercise test accurately prognoses risk of postoperative complications in patients undergoing lung resection in good functional status

目的:探讨以术前心肺运动试验(CPET)指标精准预测胸腔镜肺切除术后并发症风险的价值。方法:选取448例患者术前完成含静态肺功能检查(PFT)的CPET,术后随访至出院,以有无并发症分组:418例无并发症、30例有并发症(含1例死亡)。计算峰值摄氧量(Peak VO_(2))等核心指标,比较两亚组的异同,选取其预测风险的最佳分切值和危险系数(OR)。结果:(1)本研究患者男184/女264例,年龄(54±12,16~79)岁,吸烟85例、淋巴结转移23例、高血压68例、糖尿病45例;Peak VO_(2)和峰值负荷功率(Peak Work Rate)分别为(93.31±17.73,44~158)%pred和(99.70±22.93,53~179)%pred;用力肺活量(FVC)、最大肺活量(VC)和第一秒用力呼气容积(FEV_1)占用力肺活量比值(FEV_1/FVC)分别为(99.46±15.60,42~150)%pred、(101.58±15.77,44~148)%pred和(98.36±9.27,52~134)%pred。(2)性别、年龄、吸烟史、淋巴结转移及核心指标的Peak VO_(2)(%pred)、Peak Work Rate(%pred)、FVC、VC、静息收缩压(Rest SBP)和峰值收缩压(Peak SBP)均有显著差异(P<0.01);Peak VO_(2)(ml/(min·kg))、峰值氧脉搏(Peak VO_(2),%pred)、二氧化碳排出通气斜率(V_(E)/VCO_(2) Slope)、无氧阈时二氧化碳排出通气比值(V_(E)/VCO_(2)@AT)、峰值心率(Peak HR,bpm)、呼吸交换率(RER)、FEV_1和空腹血糖也有差异(P<0.05);其它指标无差异。(3)分切点为Rest SBP(140 mm Hg)和FEV_1(80%pred)的OR分别为4.24和3.72(P<0.01);而Peak VO_(2)(80%pred)、Peak SBP(180 mm Hg)、Peak VO_(2)(20 ml/(min·kg))和V_(E)/VCO_(2) Slope(30)的OR分别为2.66、2.62、2.43和2.12(P<0.05)。结论:功能状态好的肺切除手术患者,术前CPET核心指标能精准预测术后并发症的风险,值得深入研究。

Objective:To explore the value of predicting accurately the risk of complications after thoracoscopic lung resection by preoperative CPET index.Methods:Selected 448 patients who completed CPET with static pulmonary function test(PFT)before operation,followed up to discharge after operation,and were divided into groups according to the presence or absence of complications:418 cases had no complications and 30 cases had complications(including 1 death).Calculate peak oxygen uptake(Peak VO_(2))and other core indicators,compare the similarities and differences between patients with and without complications,and calculate the best cut value and odds ratio(OR).Results:(1)In this study,there were 184 males and 264 females,aged(54±12)(16~79)years old,85 cases with smoking,23 cases with lymph node metastasis,68 cases with hypertension,45 cases with diabetes.Peak VO_(2) and Peak WR are respectively(93.31±17.73)(44~158)%pred and(99.70±22.93)(53~179)%pred.FVC,VC and FEV1/FVC are respectively(99.46±15.60)(42~150)%pred,(101.58±15.77)(44~148)%pred and(98.36±9.27)(52~134)%pred.(2)There are significant differences(P<0.01)in gender,age,smoking history,lymph node metastasis and core indicators of Peak VO_(2)(%pred),Peak WR(%pred),FVC,VC,Rest SBP and Peak SBP.There are also differences(P<0.05)in Peak VO_(2)(ml/(min·kg)),Peak VO_(2)(%pred),V_(E)/VCO_(2)slope,V_(E)/VCO_(2)@AT,Peak HR(bmp),RER,FEV1 and fasting blood glucose.No difference in other indicators.(3)OR are respectively 4.24 and 3.72(P<0.01)when the cutting points are Rest SBP(140 mm Hg)and FEV1(80%pred).While the OR of Peak VO_(2)(80%pred)、Peak SBP(180 mm Hg)、Peak VO_(2)(20 ml/(min·kg))and V_(E)/VCO_(2) Slope(30)are respectively2.66、2.62、2.43 and 2.12(P<0.05).Conclusion:For patients undergoing thoracoscopic lung resection with good function,the preoperative CPET core indicators can accurately predict the risk of postoperative complications,which is worthy of in-depth study.