食管、贲门癌手术前肺功能评估与术后急性呼吸窘迫综合征的相关性  

Correlations of preoperative pulmonary function appraisal for esophageal cancer and carcinoma of gastric cardia to postoperative acute respiratory distress syndrome

作　　者：周栋[1] 邹良建[1] 杨勇[1] 

机构地区：[1]第二军医大学长海医院胸心外科解放军胸心外科研究所,上海200433

出　　处：《肿瘤研究与临床》2007年第10期678-680,共3页Cancer Research and Clinic

摘　　要：目的研究食管、贲门癌术前肺功能试验、屏气试验、登梯试验与术后发生急性呼吸窘迫综合征(ARDS)的相关性,为临床诊断与治疗提供依据。方法回顾性分析该院2002年至2004年胸心外科行剖胸探查食管、贲门癌根治术患者577例。分析术前肺功能试验的3个主要指标:第一秒用力呼气容积占预计值百分比(FEV1),第一秒用力呼气容积与用力肺活量比值(FEV1/FVC),最大通气量占预计值百分比(MVV)以及屏气试验、登梯试验、年龄等与术后发生 ARDS 的关系。结果 577例患者中,21例术后发生 ARDS(3.64%)。年龄与 FEV1和 MVV 的交互作用与 ARDS 的发生密切相关(P<0.001)。FEV1、FEV1/FVC、MVV 3个指标中,任何两个指标的交互作用均与 ARDS 的发生相关(P 值分别为0.001、0.005、0.048)。屏气试验、FEV1、FEV1/FVC、MVV 4个指标的交互作用与 ARDS 的发生密切相关(P<0.001)。术前重度肺功能受损的26例患者中,术后随即入 ICU15例,发生 ARDS 1例(6.67%)。其余11例术后回病房,发生 ARDS 4例(36.3%),术后早期加强监护治疗能明显降低 ARDS 发生(P<0.05)。结论食管、贲门癌术前肺功能试验、屏气试验、登梯试验与术后 ARDS 的发生有相关性,术后早期加强监护治疗是预防术后 ARDS 的重要手段。Objective To analyze the correlations of preoperative pulmonary function appraisal for esophageal cancer and carcinoma of gastric eardia to postoperative acute respiratory distress syndrome,and supply a basis for clinical diagnosis and treatment.Methods Clinical data of 577 esophageal cancer and carcinoma of gastric cardia patients from 2002 to 2004 in our hospital were retrospectively reviewed, all of them received esophagectomy.The correlations of postoperative ARDS to three parameters in pulmonary func- tion test,including forced expiratory volume in the first second(FEV1%),the ratio of FEV1 to forced vital ca- pacity(FEV1/FVC)% and maximal voluntary ventilation(MVV%),and breath holding test,climbing stairs test, age were analyzed.Results Of the 577 patients,21 suffered postoperative ARDS(3.64 %).The occurrence of ARDS was related to the interaction of age with FEV1% and MVV%.In addition,there was a correlation of postoperative ARDS with the interaction of breath holding test,FEV1%,(FEV1/FVC)%,MVV%.Of the 26 pa- tients suffered severe preoperative lung function damage,15 cases received intensive care right after operation, of whom 1(6.67 %)had ARDS;4(36.3 %)of the remaining11 had ARDS.Early postoperative intensive care significantly decreased the occurrence of ARDS(P<0.05).Conclusion Pulmonary function test,breath hold- ing test and climbing stairs test have some correlations to postoperative ARDS. Early intensive care play an important role in preventing ARDS after operation.

关 键 词：食管肿瘤 胃肿瘤 外科手术 呼吸功能试验 呼吸窘迫综合征 

分 类 号：R735[医药卫生—肿瘤]