伴有支气管阻塞肺癌患者的术前肺功能分析  

Study on preoperative pulmonary function in lung cancer patients with bronchial obstruction

作　　者：徐卫松[1] 毛友生[1] 赫捷[1] 王贵齐[1] 张蕾[1] 严少平[1] 董静思[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院胸外科,北京100021

出　　处：《中国肿瘤临床与康复》2011年第2期97-101,共5页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的通过对伴支气管阻塞的肺癌患者术前肺功能改变的分析和研究,探讨影响此类患者术前肺功能的因素和规律及以往对此类患者术前肺功能评估方法的不足之处,并对此类患者术前肺功能评估进行校正的有效方法进行讨论和提出建议。方法对406例经纤维支气管镜检查的肺癌患者进行多元线性回归,分析其肺功能指标与相应自变量间的关系。从中抽取132例患者,依据支气管阻塞程度不同分为段、叶、主支气管阻塞组(每组33例)及无阻塞组(对照组,33例),并比较各组术前肺功能测定结果的差异。选用指标包括:肺活量实测值及占预计值的百分比;用力肺活量(FVC)实测值及占预计值百分比;第1秒用力呼气量(FEV1)实测值及占预计值百分比;第1秒用力呼气量占用力肺活量的比值(FEV1/FVC)实测值及占预计值百分比;每分钟最大通气量(MVV)实测值及占预计值百分比;一氧化碳弥散量(DLCOsb)实测值及占预计值的百分比等。结果对406例患者肺功能进行多因素线性回归分析显示,术前肺功能指标主要受患者性别、年龄及阻塞的肺段数影响;取其中132例按支气管阻塞程度分组并进行多组资料方差分析显示,随着支气管阻塞平面的增高,影像学显示的各组叶及叶以上的不张或实变发生率也逐渐增高,除FEV1/FVC外的其他指标在各组间差异均有显著性(P<0.05),且各项肺功能指标实测值随阻塞水平的增高而呈依次递减的关系:段支气管阻塞组>叶支气管阻塞组>主支气管阻塞。结论伴有支气管阻塞的肺癌患者其支气管阻塞平面越高,对肺功能的损害越重,影像学显示发生肺不张或实变等阻塞性改变的机会就越大,其术前肺功能减损中限制性因素所起的作用也可能越大。以往在对此类患者的肺功能术前评估中,在预测术后肺功能时可能存在低估现象,宜对其进行校正,以适当放宽这类患者的肺切除指�Objective To study the changes of preoperative pulmonary function in the lung cancer patients with bronchial obstruction by cancer,in order to find the factors that may affect the preoperative lung function and the short coming of methods for predicting postoperative lung function in past years.Methods The relationship between the parameters of preoperative lung function and the possible factors affecting these parameters in 406 lung cancer patients examined by fiberobronchoscopy（FOB） were analyzed using multiple linear regression analysis.Of the 406 patients,132 were selected and divided into four groups according to bronchial obstruction under FOB inspection： none（33 cases）,segmental bonchus（33 cases）,lobe bronchus（33 cases）and main bronchus（33 cases）with age and sex matched in each group.The difference in the parameters of preoperative lung function of various groups were compared： including actual observed value and the actual observed value as percentage of predicted value of VC,FVC,FEV1,FEV1/FVC,MVV and DLCO.Results The results of multiple linear regression analysis on the preoperative pulmonary function in the 406 lung cancer patients showed that preoperative pulmonary function was mainly affected by sex,age and the number of obstructed lung segments.Analysis of variance of the parameters of preoperative pulmonary lung function among the above four groups showed that the occurrence of atelectasis or pulmonary consolidation detected by X-ray imaging increased with the ascendance of bronchial obstruction level.The differencess in all parameters except FEV1/FVC among different groups were significant（P〈0.05）.Furthermore,the measured value of all parameters except FEV1/FVC decreased with the ascendance of bronchial obstruction level： segmental bronchus〉 group lobe bronchus group〉 main bronchus group.Conclusion The incidence of atelectasis or consolidation of lung tissue increases with the ascendance of bronchial obstruction in lung cancer patients,the higher the bronchial ob

关 键 词：支气管阻塞 肺肿瘤 肺功能 

分 类 号：R734.2[医药卫生—肿瘤] R562.2[医药卫生—临床医学]