肺癌左全肺切除术后心肺并发症的发生与术前低肺功能的相关性  

Correlation analysis of preoperative reduced pulmonary function and postoperative cardiopulmonary complication after left pneumonectomy for lung cancer

作　　者：王丹丹[1,2] 陈情[1] 毕平[2] 

机构地区：[1]天津医科大学附属肿瘤医院心肺功能室,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市300060 [2]天津医科大学生物医学工程学院

出　　处：《中国肿瘤临床》2015年第7期397-400,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨肺癌患者术前轻度低肺功能对左全肺切除术后心肺并发症(postoperative cardiopulmonary complication,PCC)的预测能力,以期作为指导临床手术参考。方法:回顾性分析我院200例施行左全肺切除手术的肺癌患者的临床资料,根据患者术后1个月内有无发生心肺并发症分为PCC组和无PCC组,探讨术前轻度或中重度低肺功能与患者术后并发症发生的相关性,并进一步探讨肺通气功能指标(FEV1%、MVV%)轻度减低与术后PCC的关系。结果:200例患者中正常、轻度及中重度肺功能减低各35、45、120例,术后1个月内PCC发生率分别为28.6%,53.3%,62.5%,差异具有统计学意义(χ2=12.611,P=0.002);术前FEV1%轻度减低(70%≤FEV1<80%)或MVV%轻度减低(70%≤MVV%<80%)与左全切术后PCC的发生相关(P=0.028及0.014)。进一步分析显示,FEV1%或MVV%单独轻度减低时,患者术后PCC的发生差异无统计学意义(P>0.05),而FEV1和MVV同时轻度减低时,PCC的发生差异有统计学意义(χ2=6.598,P=0.010)。结论:术前FEV1%或MVV%轻度减低是影响肺癌左全肺切除后PCC的危险因素。FEV1%或MVV%单独轻度减低不能影响肺癌左全肺切除后PCC的发生,同时满足FEV1%及MVV%轻度减低是肺癌左全切术后PCC发生的危险因素,应加强围手术期管理,降低PCC的发生。Objective：To investigate the value of preoperative slight decline of the pulmonary function in predicting postoperative cardiopulmonary complications （PCC） after left total pneumonectomy of lung cancer patients to guide the clinical surgery of lung cancer. Methods：Clinical data of 200 lung cancer patients after left total pneumonectomy were retrospectively analyzed. These patients were divided into two groups （PCC and non-PCC） based on the incidence of postoperative cardiopulmonary complications within 1 month after the cancer resection. The relationship between the preoperative slight or moderate to severe reduction of pulmonary func-tion and postoperative complications was explored. The correlation between the preoperative slight decline of the pulmonary function index and PCC was also analyzed. Results：Among the 200 patients, 35, 45, and 120 demonstrated normal, slightly, and moderately to severely reduced pulmonary functions, and 28.6%, 53.3%, and 62.5% showed PCC within 1 month after the surgical resection （χ^2=12.611, P=0.002）. Significant differences in the slightly reduced pulmonary function parameters MVV% （70% ≤ MVV〈80%） and FEV1%（70%≤FEV 1%〈80%） were observed between those without and with complications （P=0.028 and 0.014）. Further analysis indicated no significant difference between the patients with preoperative slight reduction of FEV1%only or of MVV%only （P〉0.05）. However, statistically significant differences were observed when both FEV1%and MVV%were slightly reduced （χ^2=6.598, P=0.010）. Conclusion：The preoperative slight reduction values of FEV1%and MVV%were the risk factors in predicting PCC after left pneumonectomy in lung cancer patients. The slightly reduced FEV1%or MVV%alone cannot influence PCC. Both slightly reduced FEV1%and MVV%were the risk factors of PCC. Perioperative management should be strengthened for these patients to lower the incidence of PCC.

关 键 词：肺癌 全肺切除 低肺功能 术后并发症 

分 类 号：R734.2[医药卫生—肿瘤]