心肺运动试验预测肺癌侵及血管的患者术后呼吸衰竭的探讨  

The clinical significance of predicting post-operative respiratory failure with cardiopulmonary exercise test in the patients of lung cancer with the vessels invaded by tumors

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

机构地区：[1]北京胸科医院心肺功能室,101149

出　　处：《临床肺科杂志》2009年第9期1178-1181,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨心肺运动试验预测肺癌侵及血管的患者术后呼吸衰竭的探讨。方法术前采用运动负荷递增的方案对172例原发性肺癌患者行心肺运动试验,测定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)、无氧阈(AT)、代谢当量(MET)、氧脉搏(VO2/HR)、呼吸频率(BF)、通气量(VE)。结果1.运动心肺功能试验各项指标在肺叶切除术后呼衰和非呼衰组间均无显著性差异(P>0.05)。全肺切除术而言,W%、VO2%P、VO2/kg、MET、VE、BF在术后呼衰组均较非呼衰组降低(P<0.05或0.01)。2.W%、VO2%P、VO2/kg、MET在行左全肺切除术术后呼衰组较非呼衰组降低(P<0.05或0.01)。右全肺切除组仅BF在组间差异有显著性意义(P<0.05)。3.χ2检验显示,六项指标不同程度异常与全肺切除术后呼衰的发生率有关,logistic回归分析显示MET<4和BF<30次/分与全肺切除术后呼衰的发生密切相关,VO2/kg<14.6ml/min/kg与左全肺切除术后呼衰的发生关系密切。4.术后全肺切除组VO2%P<60%、BF<30次/分、VE<35L/min的敏感性和特异性均>60%,阴性预测值均大于90%。左全肺切除组W%、VO2%P<60%的敏感性和特异性均>80%,阴性预测值100%,均高于VO2/kg。结论运动心肺功能试验对于有血管侵及的肺癌患者行全肺切除术,特别是行左全肺切除术,预测术后的呼吸衰竭、为全肺切除术的适应症评估提供依据,均具有重要意义。选择VO2%P作为预测术后呼衰、评估手术适应症的指标。因MET<4、VO2/kg<14.6ml/min/kg与肺切除术后呼衰关系密切,应结合临床情况适当考虑。Objective Using cardiopulmonary exercise test（CPET） to evaluate the clinical significance of predicting post-operative respiratory failure in the patients of lung cancer with the vessels invaded by tumors. Methods Before operation, 172 patients with lung cancer had CPET with incremental protocol measuring W%, VO2 % P, VO2/kg,AT, MET, VO2/HR, BF and VE at the end of load exercise. Results （ 1 ） For the patients undergoing pneumonectomy, the values of 6 indexes of CPET in the respiratory failure group were lower than those in the non-respiratory failure group（ P 〈 0. 05 or 0.01 ）, especially in the group of left pneumonectomy. But for the patients undergoing lobectomy, all the indexes of CPXT in the respiratory failure group were similar to those in the non-respiratory failure group（ P 〉 0.05 ）. （2）χ^2 test showed that abnormality of CPET indexes in different degree were relative to the morbidity of respiratory failure after pneumonectomy. Logistic regression showed that MET 〈 4 and BF 〈 30 times/min were more relative to the morbidity of post-operative respiratory failure than other indexes. While for the group of left pneumonectomy, the significant index was VO2/kg 〈 14.6 ml/min/kg. （3） For predicting post-operative respiratory failure in the group of pneumonectomy, the sensitivity and specificity of VO2 % P 〈 60%, BF 〈 30 times/min,VE 〈 35 L/rain were more than 60% and the negative predictive values of 3 indexes were more than 90%. In the group of left pneumonectomy, the sensitivity and specificity of W%, VO2 % P 〈 60% were more than 80% and the negative predictive values of 2 indexes were more than 100%. Conclusion CPET can be used to predict post - pneumonectomy respiratory failure and to evaluate the indication of thoracatomy for the patients with lung cancer, especially for left pneumoncctomy. The most useful index is VO2% P.

关 键 词：肺癌 血管 肺切除术 运动心肺功能 

分 类 号：R734.2[医药卫生—肿瘤] R576[医药卫生—临床医学]