登楼试验联合动脉血气分析对低肺功能肺癌患者术后并发症发生的预测价值  

The predictive value of stair climbing test combined with arterial blood gas analysis on postoperative complications in lung cancer patients with limited pulmonary function

作　　者：肖飞[1] 邵为朋 郝杨 韩宇 幸华杰 张真榕[1] 梁朝阳[1] 刘德若[1] Xiao Fei;Shao Weipeng;Hao Yang;Han Yu;Xing Huajie;Zhang Zhenrong;Liang Chaoyang;Liu Deruo(Department of Thoracic Surgery,China-Japan Friendship hospital,Beijing 100029,China;Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100029,China)

机构地区：[1]中日友好医院胸外科,北京100029 [2]北京大学中日友好临床医学院,北京100029

出　　处：《中华胸心血管外科杂志》2021年第12期745-749,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨登楼试验联合动脉血气分析对低肺功能肺癌患者术后并发症发生的预测价值。方法回顾性分析我中心自2012年8月至2020年8月总计1231例低肺功能肺癌手术患者的临床资料,其中术前完成登楼试验并有数据记录者766例。按照一般状况、既往病史、手术情况、静态肺功能指标、登楼试验结果等进行分组,比较组间发生术后心肺相关并发症的比例,并筛选其独立危险因素。结果共记录术后心肺相关并发症发生182例次,发生于144例患者,占入组病例数18.8%。围手术期死亡7例,占0.9%。不同性别、年龄、吸烟指数、静态肺功能指标(FEV1%,DLCO%)、登楼试验结果(登楼高度、登楼速度,登楼前后心率变化及动脉血氧饱和度变化)、ASA评分、手术方式(VATS/开胸)、切除范围(肺叶/亚肺叶)、麻醉时间、术中出血量等的病例组间发生术后心肺相关并发症的比例显著不同。Logistic回归分析结果提示只有登楼高度(P<0.001)、登楼前后心率变化(P<0.001)、动脉血氧饱和度变化(P=0.001)、切除范围(P=0.006)和麻醉时间(P=0.025)是低肺功能肺癌患者术后心肺相关并发症发生的独立危险因素。结论登楼试验与动脉血气分析联合,可以用作低肺功能肺癌患者的术前初筛手段,对术后发生心肺相关并发症有预测价值。对低肺功能肺癌患者而言,在登楼高度、登楼前后心率变化、动脉血氧饱和度变化等达标的前提下,选择以亚肺叶切除为主的术式,同时尽可能缩短麻醉时间,或能有效减少术后并发症发生。Objective To evaluate the predictive value of stair climbing test combined with arterial blood gas analysis on postoperative complications in lung cancer patients with limited pulmonary function.Methods A total of 1231 hospitalized lung cancer patients with limited pulmonary function dating from August 2012 to August 2020 were retrospectively reviewed.Included in the cohort were 766 of patients who underwent stair climbing test(SCT)preoperatively and completed data collection.Patients were grouped according to their general condition,past medical history,surgical approach,pulmonary function test(PFT)and SCT results.Comparison of the postoperative cardiopulmonary complication rates were made between different groups,and independent risk factors were identified.Results A total of 182 cardiopulmonary-related complications occurred in 144 cases,accounting for 18.8%of the entire cohort.Perioperative mortality rate was 0.9%(7/766).The rate of postoperative cardiopulmonary complications was significantly different between the groups stratified by gender,age,smoking index,PFT index(FEV1%,DLCO%),SCT results(height achieved,speed,changes in heart rate and oxygen saturation of the arteries before and after the test),ASA score,surgical approach(VATS/Open),resection range(Lobectomy/Sublobectomy),anesthetic duration,blood loss volume,etc.Logistic regression analysis showed that only height achieved(P<0.001),changes in heart rate(P<0.001),changes in oxygen saturation of the arteries(P=0.001),resection range(P=0.006)and anesthetic duration(P=0.025)were independent risk factors for cardiopulmonary-related complications in lung cancer patients with limited pulmonary function.Conclusion The stair climbing test combined with arterial blood gas analysis could be used as a preoperative screening method for lung cancer patients with limited lung function and may have a predictive value for postoperative cardiopulmonary-related complications.

关 键 词：登楼试验 血气分析 肺切除手术 术后并发症 

分 类 号：R734.2[医药卫生—肿瘤]