心肺功能综合评估预测肺癌术后呼吸衰竭危险  

The study on the evaluation of thoractomy candidates in the patients with lung cancer using cardiopulmonary scores

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

机构地区：[1]北京市结核病胸部肿瘤研究所心肺功能室,101149

出　　处：《中华胸心血管外科杂志》2006年第3期164-166,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨心肺功能综合评估预测肺癌病人手术后呼吸衰竭(呼衰)危险。方法260例原发性肺癌病人于术前行静息肺功能、心电图、运动心肺功能检测,将常用指标分别组合为静息肺功能、运动肺功能、心功能进行评分,并计算心肺功能综合评分。结果(1)全肺切除术后呼衰组运动肺功能、心功能、心肺功能综合评分均高于非呼衰组(P<0.01),Logistic分析显示运动肺功能评分>3分、心功能评分>2分与术后呼衰的发生密切相关,其OR值、预测术后呼衰的敏感性、特异性和阳性结果预计值均高于VO2kg。(2)肺叶切除术后呼衰组仅静息肺功能评分高于非呼衰组(P<0.05),Logistic分析显示静息肺功能评分>2分与其术后呼衰的发生密切相关。(3)FEV1.0<60%、行肺叶切除术(低肺功能组)术后呼衰组运动肺功能评分和心肺功能综合评分高于非呼衰组(P<0.01),Logistic分析显示心肺功能综合评分>6分与其术后呼衰的发生密切相关,其OR值、预测术后呼衰的敏感性和阴性结果预计值高于VO2kg。结论心肺功能综合评估较单项肺功能指标能更全面、准确地预测术后呼衰发生危险,尤其适于全肺切除和低肺功能、行肺叶切除术病人。Objective To study the clinical significance of evaluation of thoractomy candidates using cardiopulmonary scores in the lung cancer patients. Methods 260 patients with lung cancer were tested for static lung function, electrocardiogram and eardiopulmonary exercise test. Some regular indexes of cardiopulmonary function were realigned and given scores for static lung function （SLF）, exercise lung function（ELF）, cardiac funetien（CF） and eardiotpulmonary function（CPF）. Results For the patients received pneumoneetomy, the scores of ELF, CF and CPF in the group of pest-operative respiratory failure were higher than in the group of nonrespiratory failure （ P 〈 0.01 ）. Logistic analysis showed that ELF 〉 3 and CF 〉 2 were related with post-operative respiratory failure. The OR, sensitivity, specificity and positive predictive value of ELF 〉 3 and CF 〉 2 were higher than X/O2/kg For the patients received lobectomy, only the score of SLF in the group of post-operative respiratory failure were higher than in the group of non-respiratory failure （ P〈 0.05）. Logistic analysis showed that SLF〉2 was related with post-operative respiratory failure. For the patients received lobectomy whose FEV1.0 was lower than 60%, the scores Of ELF and CPF in the group of pest-operative respiratory failure were higher than in the group of non-respiratory failure （ P 〈 0.01 ）. Logistic analysis showed that CPF 〉 6 was related with post-operative respiratory failure. The OR, sensitivity and negative predictive value of CPF 〉 6 were higher than VO2/kg. Conclusion Comparing with single index of pulmonary function, the eardinpulmenary scores can more comprehonsively evaluate the thoractomy candidates, for pationts receiving pneumoneetomy or the patients receiving lobectomy whose FEV1.0 was lower than 60%.

关 键 词：肺肿瘤 肺切除术 呼吸功能试验 心脏功能试验 

分 类 号：R734.2[医药卫生—肿瘤]