心肺运动试验在食管癌患者术后并发症预测中应用的回顾性队列研究  

Predictive value of cardiopulmonary exercise test in the postoperative complications in patients with esophageal cancer:A retrospective cohort study

作　　者：任梦怡 李瑾 张明[1,2,3] 张淼 高民[3] 陈伟[1,2,3] REN Mengyi;LI Jin;ZHANG Ming;ZHANG Miao;GAO Min;CHEN Wei(The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University,Xuzhou,221010,Jiangsu,P.R.China;Xuzhou Clinical College of Xuzhou Medical University,Xuzhou,221009,Jiangsu,P.R.China;Xuzhou Central Hospital,Xuzhou,221009,Jiangsu,P.R.China)

机构地区：[1]徐州医科大学附属徐州康复医院,江苏徐州221010 [2]徐州医科大学徐州临床学院,江苏徐州221009 [3]徐州市中心医院,江苏徐州221009

出　　处：《中国胸心血管外科临床杂志》2024年第8期1148-1155,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：徐州市引进临床医学专家团队项目(2018TD007);徐州市科技项目(KC20136)。

摘　　要：目的探讨心肺运动试验(cardiopulmonary exercise test,CPET)对食管癌手术患者术后并发症的预测价值。方法纳入徐州市中心医院胸外科2018年1月—2022年3月收治的食管癌根治术患者。收集患者的临床资料和CPET相关数据(含肺功能),单因素和多因素logistic回归分析食管癌术后并发症的危险因素。结果共纳入77例食管癌手术患者,其中男59例(76.6%)、女18例(23.4%),年龄47~80岁。非并发症组42例(54.5%),并发症组35例(45.5%)。单因素分析结果显示:年龄、体重指数(body mass index,BMI)、吸烟指数、肿瘤分期、术后住院时间、峰值功率(peak work rate,WRpeak)、峰值公斤摄氧量(peak oxygen uptake per kilogram,VO_(2)peak/kg)、二氧化碳通气当量斜率(ventilatory equivalent for carbon dioxide slope,VE/VCO_(2) slope)、第1秒用力呼气量占用力肺活量的百分比(forced expiratory volume in the first second/forced vital capacity,FEV1/FVC)、最大呼气中段流速(maximum expiratory flow rate,MMEF)与术后并发症显著相关(P<0.05)。多因素分析结果显示:BMI[OR=1.35,95%CI(1.03,1.77),P=0.031]、VO2peak/kg[OR=0.64,95%CI(0.45,0.93),P=0.018]、无氧阈摄氧量(oxygen uptake-anaerobic threshold,ATVO2)[OR=0.66,95%CI(0.44,0.98),P=0.044]、VE/VCO_(2) slope[OR=1.49,95%CI(1.10,2.02),P=0.011]是食管癌根治术后并发症发生的独立危险因素。BMI、VO2peak/kg、ATVO2/kg和VE/VCO_(2) slope预测术后并发症的灵敏度为82.10%,特异度为87.44%,95%CI(0.744,0.955),预测准确性较好。结论BMI、VO2peak/kg、ATVO2/kg、VE/VCO_(2) slope可作为食管癌术后并发症的预测指标。Objective To explore the predictive value of cardiopulmonary exercise test(CPET)combined with clinical indexes in the postoperative complications.Methods The clinical data and CPET data(including lung function)of patients undergoing radical esophagectomy in Xuzhou Central Hospital from January 2018 to March 2022 were collected.Univariate analysis and multivariate logistic regression analysis were used to analyze the meaningful evaluation index for the occurrence of postoperative complications.Results A total of 77 patients with esophageal cancer were included,including 59(76.6%)males and 18(23.4%)females aged 47-80 years.There were 42(54.5%)patients in the noncomplication group and 35(45.5%)patients in the complication group.Univariate analysis results showed that the occurrence of postoperative complications was significantly correlated with age,body mass index(BMI),smoking index,tumor stage,the length of postoperative hospital stay,peak work rate(WRpeak),peak kilogram oxygen uptake(VO_(2)peak/kg),the ventilatory equivalent for carbon dioxide slope(VE/VCO2 slope),forced expiratory volume in the first second/forced vital capacity(FEV1/FVC)and maximum expiratory flow rate(MMEF)(P<0.05).The results of multivariate logistic regression analysis showed that BMI[OR=1.35,95%CI(1.03,1.77),P=0.031],peakVO_(2)/kg[OR=0.64,95%CI(0.45,0.93),P=0.018],oxygen uptake-anaerobic threshold(ATVO_(2))[OR=0.66,95%CI(0.44,0.98),P=0.044]and VE/VCO2 slope[OR=1.49,95%CI(1.10,2.02),P=0.011]were the related indexes of complications after radical resection of esophageal cancer.The sensitivity of BMI,VO_(2)peak/kg,ATVO_(2)/kg and VE/VCO2 slope in predicting postoperative complications was 82.10%,and the specificity was 87.44%,95%CI(0.744,0.955).Conclusion BMI,VO_(2)peak/kg,ATVO_(2)/kg and VE/VCO2 slope can be used as predictors for postoperative complications of esophageal cancer.

关 键 词：食管癌 术后并发症 心肺运动试验 肺功能 

分 类 号：R735.1[医药卫生—肿瘤]