登楼试验在低肺功能肺癌患者术前心肺功能评估中的应用  

Application of stair climbing test in preoperative evaluation for patients of lung cancer with lower pulmonary function

作　　者：朱勇[1] 杜贾军[1] 陈景寒[1] 

机构地区：[1]山东大学山东省立医院胸外科

出　　处：《中华全科医师杂志》2007年第10期616-619,共4页Chinese Journal of General Practitioners

摘　　要：目的评价登楼试验在判断低肺功能肺癌患者能否承担手术治疗中的作用。方法将需行肺叶切除术的418例肺癌患者按肺功能检查结果分为肺功能正常(NPF)组(357例)和低肺功能(LPF)组(61例)。NPF 组行手术治疗;LPF 组行登楼试验,对90 s 内可以登楼76级台阶、静息状态呼吸室内空气时动脉血氧饱和度>90%的48例患者进行术前功能锻炼后行手术治疗,另外13例行保守治疗。观察术后两组的并发症情况,比较 LPF 组有、无并发症者的登楼试验结果。结果手术治疗的405例患者术后出现并发症51例(12.6%),其中心律失常14例、心功能衰竭7例、心肌梗死1例、肺部感染16例、肺不张6例、肺动脉栓塞1例、呼吸衰竭6例(其中1例死亡)。其中 NPF 组的并发症发生率为11.5%(41/357),低于 LPF 组的20.8%(10/48),但差异无统计学意义(P>0.05)。LPF 组有无并发症患者的一氧化碳弥散量占预计值百分比、登楼前后心率变化值差异有统计学意义(P<0.05),登楼时间和登楼前后动脉血氧饱和度变化值的差异无统计学意义(P>0.05)。结论静态肺功能测定显示不宜行肺叶切除的肺癌患者,通过术前登楼试验筛选,可使部分患者重新得到手术治疗的机会。Objective To assess the role of stair climbing test in preoperative patients of lung cancer with lower pulmonary function if they could tolerate the planned resectional surgery. Methods Totally, 418 patients of lung cancer being considered lobectomy underwent spirometry test, who were divided into two groups, 61 patients in lower pulmonary function （LPF） group with forced expiratory volume in one second （FEV1 ） % predicted （ FEV1% ） less than 60% , and 357 patients in normal pulmonary function （NPF） group with FEV1% equal to or greater than 60% having received lobectomy. Stair climbing test was performed in patients of LPF group, and surgery was performed in 48 of them who could climb 76 steps （0. 145 m for one step in height） in 90 s with saturated arterial oxygen pressure greater than 90% , and their clinical status was observed. Patients with lower pulmonary function were divided again into two subgroups, one without and the other with postoperative cardiopulmonary complications, and their clinical characteristics and their preoperative pulmonary function were compared. Results Fifty-one of 405 patients （ 12.6% ） with lobectomy had cardiopulmonary complications, 16 with pneumonia, 14 cardiac arrhythmia, seven cardiac failure, six respiratory insufficiency （one death of them） , six atelectasis, one myocardial infarction and one pulmonary embolism. Risk of complications increased in LPF group （20. 8% , 10/48）, as compared to that in NPF group of 11.5% （41/357）, but without statistically significant difference （P 〉 0.05）. Significant difference in diffused carbon monoxide percentage and change of heart rates before and after stair climbing test was found in LPF group （P 〈 0.05）. No significant difference in FEV1%, age, weight, marimum voluntary ventilation （MVV） % predicted, vital capacity （VC） %, post-operative FEV1 % , time taken for stair climbing, change of arterial oxygen saturation percent before and after stair climbing in LPF group was found （ P �

关 键 词：呼吸功能试验 肺肿瘤 运动试验 

分 类 号：R734.2[医药卫生—肿瘤]