心肺运动试验评估肺功能减退的肺癌患者手术适应证探讨  

Cardiopulmonary exercise test in evaluation of operative indication in patients with lung cancer accompanied by lung dysfunction

作　　者：李琦[1] 操敏[1] 阮红云[1] 张国红[1] 孙桂新[1] 东博涛[1] 王志茹[1] 

机构地区：[1]北京市结核病胸部肿瘤研究所心肺功能室,北京101149

出　　处：《中国胸心血管外科临床杂志》2004年第3期192-195,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨心肺运动试验对肺功能减退的肺癌患者手术适应证评估的临床意义。　方法　术前采用运动负荷递增的方案 ,测定 195例肺功能减退的肺癌患者终止负荷运动时的功率 (W% )、最大摄氧量 (·VO2 % P)、公斤氧耗量 (·VO2 /kg)等指标 ,并对术后有呼吸衰竭和无呼吸衰竭患者中上述指标的异常发生率行单因素和 logistic多因素分析。　结果　全肺切除术后有呼吸衰竭患者 W%、·VO2 % P、·VO2 /kg、代谢当量 (MET)、每分通气量 (·VE)、呼吸频率 (BF)均低于无呼吸衰竭患者 (P<0 .0 5或 0 .0 1) ,logistic回归分析显示 ·VE<30 L/min和 BF<30次 /分与术后有呼吸衰竭发生密切相关。肺叶切除术后上述指标两者间差别无显著性意义 ,但一秒率 (FEV1 % ) <6 0 %、肺叶切除术后有呼吸衰竭者上述指标降低 (P<0 .0 5或 0 .0 1) ;logistic回归分析显示 ·VO2 % P<6 0 %与术后呼吸衰竭密切相关。结论　心肺运动试验可用于肺功能减退肺癌患者手术适应证的评估 ,应选择 ·VO2 % P<6 0Objective To evaluate the clinical significance of operative indication in patients with lung cancer accompanied by lung dysfunction using cardiopulmonary exercise test (CPET). Methods Before operation, using CPET with step program, work rate(W%), maximal oxygen uptake(·VO_2%P), maximal oxygen uptake per kilogram(·VO_2/kg) and other indexes were tested in the end of load exercise in 195 patients with lung cancer accompanied by lung dysfunction. Chi-square test and logistic regression analysis were performed for the abnormal rate of indexes mentioned above in patients with or without postoperative respiratory failure. Results After pneumonectomy, W%,·VO_2%P, ·VO_2/kg, metabolic equivalent (MET), minute ventilation(·V_E) and respiratory frequency(BF) in patients with postoperative respiratory failure were lower than those in patients with non-postoperative respiratory failure (P<0.05 or 0.01). Logistic regression analysis showed that ·V_E<30 L/min and (BF<30) times/min were more related to the morbidity of postoperative respiratory failure than other indexes. As for the patients with lung dysfunction treated by lobectomy, this indexes didn't show any significant difference between patients with or without postoperative respiratory failure. However, this indexes decreased in patients with postoperative respiratory failure whose ratio of forced expiratory volume in one second to forced vital capacity (FEV_(1)%) were lower than 60%(P<0.05 or 0.01). Logistic regression analysis showed that ·VO_2%P<60% related to the morbidity of postoperative respiratory failure. Conclusion CPET is useful to evaluate the operative indication in patients with lung cancer accompanied by lung dysfunction. ·VO_2%P<60% should be selected as a evaluating index.

关 键 词：心肺运动试验 肺功能减退 肺癌 手术适应证 心肺运动试验 

分 类 号：R734.2[医药卫生—肿瘤] R655.3[医药卫生—临床医学]