高精度超声肺功能仪预测肺切除术后肺部并发症风险的分析研究

Analytical investigation of ultrasonic pulmonary function sensor with high-precision in predicting the PPC risk after pneumonectomy

目的:探讨高精度超声肺功能仪与压差传感器肺功能仪评估儿童肺功能的差异性,研究术前超声肺功能仪检测对肺癌肺切除术患者术后肺部并发症(PPC)的预测评估特点。方法:选取医院收治的158例肺癌拟行开胸肺切除手术的患者,所有患者术前均采用超声肺功能检测仪和压差传感器肺功能仪进行肺功能检测,根据肺功能检测结果将患者分为肺功能正常组(91例)、肺功能轻度异常组(35例)和肺功能重度异常组(32例)。①比较两种肺功能仪获取的肺通气功能参数第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)、用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、最大呼气流量(FEF%pred)、用力呼出25%肺活量时的瞬间流量占预计值的百分比(FEF25%pred)、用力呼出50%肺活量时的瞬间流量占预计值的百分比(FEF50%pred)、用力呼出75%肺活量时的瞬间流量占预计值的百分比(FEF75%pred)、最大呼气中期流量(MMEF%pred);②根据3组术后发生PPC情况再将患者分为PPC组和无PPC组,比较两组超声肺功能各指标的异同;分析术前超声波肺功能仪测量结果与PPC发生的相关性。结果:超声肺功能仪与压差传感器肺功能仪检测肺功能指标FVC%pred、FEV1%pred、FEF%pred、FEF25%pred、FEF50%pred和FEF75%pred参数值比较,差异有统计学意义(t=3.960,t=4.211,t=3.989,t=4.527,t=4.639,t=-11.277;P<0.05),而FEV1/FVC、MMEF%pred参数值差异无统计学意义(t=0.797,t=0.528;P>0.05)。肺功能重度异常组PPC发生率显著高于正常组和轻度异常组,差异有统计学意义(χ^(2)=7.242,χ^(2)=5.301;P<0.05),正常组与轻度异常组间PPC发生率比较,差异有统计学意义(χ^(2)=4.197,P<0.05)。超声肺功能术前检测异常率与PPC的发生显著相关(r=0.457,P<0.05);回归分析显示,MVV%、DLCO%-PPo、FEV1/FVC%、DLCO%pred与PPC发生显著相关(OR=2.18,OR=1.56,OR=2.62,OR=1.93;P<0.05)。结论:高精度超声肺功能仪准确性和重复性良好,肺功能检测参数值与压差式肺功能参数值有差异性,术前超声肺功能测量核心指标与肺切除术后PPC的发生具有密切的相关性,其预测结果对于肺切除手术患者术后肺部并发症的预测价值较高。

Objective:To explore the difference between ultrasonic sensor with high-precision and differential pressure transducer in assessing pulmonary function of children,so as to study the characteristics of the detection of preoperative ultrasonic pulmonary function instrument in the predicting and evaluating postoperative pulmonary complications(PPC)of patients with lung cancer who underwent pneumonectomy.Methods:A total of 158 patients with lung cancer who prepared to undergo pneumonectomy were selected.All patients adopted ultrasonic pulmonary function instrument and differential pressure transducer to detect lung function before surgery.According to the detection results of lung function,the patients were divided into normal lung function group(91cases),mildly abnormal lung function group(35cases)and severely abnormal lung function group(32cases).①The series of parameters of pulmonary ventilation function,which included the ratio of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC),the percentage of FVC in the predicted value(FVC%pred),the percentage of FEV1 in the predicted value(FEV1%pred),the maximum expiratory flow(FEF%pred),the percentage of the instantaneous flow at 25%forced vital capacity in the predicted value(FEF25%pred),the percentage of the instantaneous flow at 50%forced vital capacity in the predicted value(FEF50%pred),the percentage of the instantaneous flow at 75%forced vital capacity in the predicted value(FEF75%pred)and the maximum mid-expiratory flow rate(MMEF%pred),were respectively obtained from two kinds of pulmonary function instruments were compared.②these patients were divided into PPC group and non-PPC group according to the conditions of occurring PPC in 3 groups,and the differences of each indicator of ultrasonic pulmonary function between two groups were compared.The correlation between the measured results of ultrasonic pulmonary function instrument before surgery and the PPC occurrence was further analyzed.Results:The differences of FVC%pred,FEV1%pred,FEF%pred,FEF25%pred,FEF50%pred and FEF75%pred of pulmonary function indicators between ultrasonic pulmonary function instrument and the pulmonary function instrument of differential pressure transducer were significant(t=3.960,t=4.211,t=3.989,t=4.527,t=4.639,t=-11.277,P<0.05),while the differences of the values of FEV1/FVC and MMEF%pred between them were no significant(t=0.797,t=0.528,P>0.05).The PPC incidence of the severely abnormal lung function group was significantly higher than that in the normal group and the mildly abnormal lung function group,with statistical significance(χ^(2)=7.242,χ^(2)=5.301,P<0.05),respectively,and the difference of the PPC incidence between normal group and mildly abnormal lung function group(χ^(2)=4.197,P<0.05).The abnormal rate of preoperative ultrasonic pulmonary function detection was significantly correlated with the PPC occurrence(r=0.457,P<0.05).Regression analysis showed that MVV%,DLCO%-PPo,FEV1/FVC%,DLCO%pred were significantly correlated with PPC occurrence(OR=2.18,OR=1.56,OR=2.62,OR=1.93,P<0.05).Conclusion:The accuracy and repeatability of the new type of ultrasonic lung function instrument are favorable,and there is difference between the parameter values of conventional lung function test and differential pressure transducer.The core indicators of preoperative ultrasonic lung function test are closely correlation with the PPC occurrence after pneumonectomy,and the predictive results of that has higher prediction value for the PPC of patients who undergo pneumonectomy.