肺癌患者术前肺通气功能、血气指标与根治术后发生呼吸衰竭的关系探讨  

Study on the relationship between preoperative pulmonary ventilation function,blood gas indexes and respiratory failure after radical surgery in patients with lung cancer

作　　者：凌慧 陈一彪 胡敏 赵海霞 余建美 LING Hui;YU Jianmei;CHEN Yibiao;HU Min;ZHAO Haixia(Department of Intensive Care Unit,Affiliated Cancer Hospital of Nantong University/Nantong Cancer Hospital,Nantong Jiangsu 226000,China)

机构地区：[1]南通大学附属肿瘤医院/南通市肿瘤医院重症医学科,江苏南通226000 [2]南通大学附属肿瘤医院,南通市肿瘤医院胸外科,江苏南通226000

出　　处：《中国急救复苏与灾害医学杂志》2024年第12期1596-1599,1604,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省自然科学基金青年项目(编号:BK20220236)。

摘　　要：目的探讨肺癌患者术前肺通气功能、血气指标与根治术后发生呼吸衰竭(RF)的关系。方法回顾性选取2022年2月—2024年1月于南通市肿瘤医院实施根治术的103例肺癌患者为研究对象,根据是否术后并发RF将患者分为RF组(37例)和无RF组(66例)。比较两组患者的临床资料、肺通气功能指标和血气指标,采用Logistic回归分析肺癌根治术后并发呼吸衰竭的影响因素,绘制相关的列线图模型并评价。结果两组患者在吸烟指数、第1秒用力呼气量(FEV_(1))、第1秒用力呼气量实测值占预测值的比值(FEV_(1)/FVC)、肺气肿指数(EI)、呼吸峰值流速(PEF)、肺弥散容量(DLco/SB)、动脉血氧分压(Pa O_(2))、动脉二氧化碳分压(Pa CO_(2))、氧合指数(OI)方面比较,差异均具有统计学意义(P<0.05)。Logistic回归分析显示,吸烟指数、FEV_(1)、FEV_(1)/FVC、EI、DLco/SB、PEF、Pa O_(2)、Pa CO_(2)、OI为肺癌根治术后发生RF的危险因素。ROC曲线结果显示,模型的曲线下面积为0.979(95%CI:0.957~1),表明模型区分度良好。Bootstrap验证表明,模型的偏差校准曲线与理想曲线吻合良好。结论行肺癌根治术患者术前肺通气功能和血气指标对术后发生RF预测具有重要价值,由其构建的列阵图可有效预测术后发生RF风险。Objective To study the relationship between preoperative pulmonary ventilation function,blood gas indexes,and the occurrence of respiratory failure(RF)after radical surgery in patients with lung cancer.Methods A retrospective analysis was conducted on 103 lung cancer patients who underwent radical surgery at Nantong Cancer Hospital from February 2022 to January 2024.Patients were divided into RF group(37 cases)and NRF group(66 cases)based on the postoperative complication of RF.Clinical data,pulmonary ventilation function indicators,and blood gas indexes were compared between the two groups.Logistic regression analysis was used to identify the factors for postoperative RF,and related nomogram models were evaluated.Results There were significant differencesin smoking index,forced expiratory volume in the first second(FEV1),the ratio of FEV1 to predicted value(FEV1/FVC),emphysema index(EI),peak expiratory flow(PEF),diffusing capacity of the lung for carbon monoxide per unit of lung volume(DLco/SB),arterial oxygen pressure(PaO2),arterial carbon dioxide pressure(PaCO2),and oxygenation index(OI)between the two groups(P<0.05).Logistic regression analysis showed that smoking index,FEV1,FEV1/FVC,EI,DLco/SB,PEF,PaO2,PaCO2 and OI are risk factors for RF after radical surgery.The ROC curve results showed that the area under the curve was 0.979(95%CI:0.957-1),indicating good model discrimination.Bootstrap validation confirmed the nomogram's calibration curve fits well with the ideal curve.Conclusion Preoperative pulmonary ventilation function and blood gas indexes are of great value in predicting the occurrence of RF after radical surgery in patients with lung cancer.The established nomogram could be useful to predict the risk of postoperative respiratory failure.

关 键 词：肺癌 根治术 肺通气功能 血气分析指标 呼吸衰竭 

分 类 号：R734.2[医药卫生—肿瘤]