上消化道手术患者术前肺功能检查指标对术后肺炎的预测价值研究

Predictive value of preoperative pulmonary function test indexes for postoperative pneumonia in patients undergoing upper gastrointestinal surgery

目的分析上消化道手术患者术前肺功能指标与术后肺炎的关系。方法前瞻性收集与分析2020年9月—2021年1月在四川大学华西医院接受肺功能检查并行上消化道手术303例患者的临床资料,其中男217例、女86例,平均年龄(61.61±10.42)岁。肺功能从通气功能、肺容量、弥散功能和气道阻力4个方面进行评价,本研究收集的肺功能指标均用实测值占预计值的百分比表示。结局指标为术后30 d内是否发生肺炎。应用logistic回归分析术前肺功能指标与术后肺炎的关系。结果全组共196例胃癌患者和107例食管癌患者,上消化道手术患者术后肺炎的发生率为26.7%(81/303)。术前低最大呼气流量患者发生术后肺炎的风险是正常患者的3.094倍[OR=3.094,95%CI(1.362,7.032),P=0.007]。未发现其它术前肺功能指标与术后肺炎的相关性。结论术前最大呼气流量可能为预测上消化道手术患者术后肺炎发生的重要指标。

Objective To analyze the relationship between preoperative pulmonary function indexes and postoperative pneumonia(POP)in patients undergoing upper gastrointestinal surgery.Methods The clinical data of 303patients who underwent lung function examination and upper gastrointestinal surgery in West China Hospital,Sichuan University from September 2020 to January 2021 were prospectively collected and analyzed.There were 217 males and 86females,with an average age of 61.61±10.42 years.Pulmonary function was evaluated from four aspects including ventilatory function,pulmonary volume,diffusion function and airway resistance.Relevant pulmonary function indicators were displayed as the percentage of actual measured value to predicted value(%pred).The outcome index was pneumonia within 30 days after the surgery.Logistic regression was used to analyze the relationship between preoperative pulmonary function indicators and POP.Results A total of 196 patients with gastric cancer and 107 patients with esophageal cancer were included,and the incidence of POP in patients undergoing upper gastrointestinal surgery was 26.7%(81/303).Patients with preoperative low peak expiratory flow(PEF%pred)had a 3.094 times higher risk of developing POP than those with normal PEF%pred[OR=3.094,95%CI(1.362,7.032),P=0.007].The incidence of POP had no correlation with the other preoperative indicators.Conclusion Preoperative PEF%pred may be an important indicator for predicting the occurrence of POP in patients undergoing upper gastrointestinal surgery.