V_(E)/VCO_(2)斜率对肺癌肺叶切除术后心血管并发症的预测意义

Significance of V_(E)/VCO_(2) slope in predicting cardiovascular complications after pulmonary lobectomy for lung cancer

目的分析二氧化碳通气当量(V_(E)/VCO_(2))斜率对肺癌肺叶切除术后心血管并发症的预测意义。方法选择2021年3月至2022年3月我院收治的169例接受胸腔镜肺癌肺叶切除术患者。术后随访30 d,术后有并发症31例为观察组,无并发症138例对照组。比较两组V_(E)/VCO_(2)斜率和临床资料。结果观察组31例中,7例出现心血管并发肺部并发症,4例肺栓塞,15例心率不齐,16例血压过低,2例心力衰竭,1例需要心肺复苏;术后30 d,观察组和对照组各死亡1例。再次入住ICU观察组18例(58.06%)高于对照组14例(10.14%)(P<0.05);观察组平均住院时长8.0(6.5~13.0)d、ICU入住时长5.0(3.0~8.0)d长于对照组6.0(5.0~7.0)d,2.0(2.0~3.0)d(P<0.05);观察组静息状态VCO_(2)0.22 ml/min、VE 7.91 L/min,PETCO_(2)28.10 mmHg,运动峰值VCO_(2)1.47 ml/min和PETCO_(2)33.07 mmHg较对照组静息状态VCO_(2)0.27 ml/min、VE 10.85 L/min,PETCO_(2)29.80 mmHg,运动峰值VCO_(2)1.72 ml/min和PETCO_(2)36.20 mmHg降低,观察组VE/VCO_(2)斜率31.86较对照组28.79升高(P<0.05)。单变量和多变量Logistic回归表明,VE/VCO_(2)斜率与心血管并发症(OR=1.074;95%CI:1.004~1.149;P=0.039)相关。VE/VCO_(2)斜率预测肺癌肺叶切除术后心血管并发症的灵敏度、特异度及AUC分别为78.13%、89.66%、0.893。VE/VCO_(2)与ICU住院时长相关,b=0.31,F=19.123,t=3.066,P=0.003。结论VE/VCO_(2)斜率可用于预测肺癌肺叶切除术后心血管并发症,具有临床意义。

Objective To analyze the predictive value of carbon dioxide ventilation equivalent(V_(E)/VCO_(2))slope on postoperative cardiovascular complications in patients with carcinoma of the lungs undergoing lobectomy.Methods A total of 169 patients with lobectomy were admitted to the hospital from March 2021 to March 2022,who were all treated with thoracoscopic lobectomy.The patients were followed up for 30 days and divided into observation group(complications)and control group(no complications)according to the prognosis.The V_(E)/VCO_(2) slope of the observation group and the control group were compared,and the clinical data of the observation group and the control group were compared,and the influencing factors of postoperative cardiovascular complications in patients with pulmonary lobectomy were analyzed,and the predictive value of V_(E)/VCO_(2) slope for postoperative cardiovascular complications in patients with pulmonary lobectomy was analyzed.Results 31 patients in the observation group,7 cases cardiovascular complications,4 cases pulmonary embolism,15 cases arrhythmia,16 cases hypotension,2 cases heart failure and 1 case required cardiopulmonary resuscitation;After surgery 30 d,1 case each died in the observation and control groups.There were 14 patients re-admitted to ICU in the control group and 18 in the observation group(10.14%vs.58.06%,χ^(2)=37.869,P=0.000).The length of hospitalization[8.0(6.5,13.0)vs.6.0(5.0,7.0),P=0.000]and the duration of ICU stay[5.0(3.0,8.0)vs.2.0(2.0,3.0),P=0.000]in the observation group were both significantly longer than that in the control group.In addition,VCO_(2),VE and PETCO_(2) at resting state,as well as VCO_(2) and PETCO_(2) at peak exercise were significantly decreased in observation group,and the slope of V_(E)/VCO_(2) was significantly increased(P<0.05).Univariate and multivariate logistic regression showed that V_(E)/VCO_(2) slope was associated with cardiovascular complications(OR=1.074;95%CI:1.004~1.149;P=0.039)correlation.The sensitivity,specificity and AUC of V_(E)/VCO_(2) slope in predicting postoperative cardiovascular complications in lobectomy patients were 78.13%,89.66%and 0.893,respectively.V_(E)/VCO_(2) were significantly correlated with length of stay in ICU(b=0.31,F=19.123,t=3.066,P=0.003).Conclusion V_(E)/VCO_(2) slope can be used to predict postoperative cardiovascular complications in patients with pulmonary lobectomy,and it has high predictive value.