心肺运动试验预测肺癌患者术后呼吸衰竭的探讨  

Evaluation of cardiopulmonary exercise test on predicting post-operative respiratory failure in patients with lung cancer

作　　者：李琦[1] 操敏[1] 张国红[1] 孙桂新[1] 东博涛[1] 阮红云[1] 王志茹[1] 

机构地区：[1]北京市结核病胸部肿瘤研究所心肺功能室,101149

出　　处：《中国肺癌杂志》2003年第5期367-370,共4页Chinese Journal of Lung Cancer

摘　　要：目的　探讨心肺运动试验预测肺癌患者术后呼吸衰竭的临床意义。方法　采用运动负荷递增的方案对 2 60例原发性肺癌患者行术前心肺运动试验 ,测定终止负荷运动时的功率 (W % )、最大摄氧量( VO2 %P)、公斤氧耗量 ( VO2 /kg)、无氧阈 (AT)、代谢当量 (MET)、氧脉搏 (O2 pulse)、潮气量 (VTe)、呼吸频率(BF)、通气量 ( VE)。结果　 ( 1)除VTe外 ,全肺切除术后呼衰组其余八项指标均显著低于非呼衰组 (P <0 .0 5或P <0 .0 1)。肺叶切除术后呼衰组上述所有指标与非呼衰组无显著性差异 (P >0 .0 5 ) ,将肺叶切除患者分为上叶切除和下叶切除组分析时发现 ,仅下叶切除术后呼衰组W %低于非呼衰组 (P <0 .0 5 )。 ( 2 ) χ2 检验显示 ,八项指标不同程度异常与全肺切除术后呼衰的发生率有关 ,logistic回归分析显示O2 pulse <80 %和BF <3 0次 /分与全肺切除术后呼衰的发生密切相关。 ( 3 ) VO2 %P <60 %、BF <3 0次 /分、 VE<3 5L/min预测术后衰竭的敏感性和特异性均 >60 % ,阴性预测值均大于 90 %。结论　心肺运动试验更适于预测全肺切除术后呼衰的可能性 ,由于 VO2 %P是一项反映运动心肺功能的综合指标 ,建议选择 VO2 %P <60 %作为预测术后呼衰、评估手术适应证的指标。Objective To evaluate the clinical significance of predicting post operative respiratory failure in patients with lung cancer using cardiopulmonary exercise test (CPET). Methods Before operation, 260 patients with lung cancer underwent CPET with incremental protocol. W%, O 2%P, O 2/kg, AT, MET, O 2 pulse, V Te, BF and E were measured in the end of load exercise. Results (1) In patients after pneumonectomy, the values of the above indexes of CPET in the respiratory failure group were significantly lower than those in the non respiratory failure group ( P <0.05 or P <0.01) except V Te. In patients after lobectomy, the values of 9 indexes of CPET in the respiratory failure group were similar to those in the non respiratory failure group ( P >0.05). However, when the patients after lobectomy were further divided into groups of upper and lower lobectomy, W% in the respiratory failure group was remarkably lower than that in the non respiratory failure group after lower lobectomy ( P <0.05). (2) χ 2 test showed that abnormality of CPET indexes in different degrees was related to the morbidity of respiratory failure after pneumonectomy. Logistic regression showed that O 2 pulse<80% and BF<30/min correlated with the morbidity of post operative respiratory failure. (3) For predicting post operative respiratory failure, the sensitivity and specificity of O 2%P<60%, BF<30/min, E<35 L/min were all more than 60% and their negative predictive values were all more than 90%. Conclusion CPET is suitable to predict post pneumonectomy respiratory failure. As a comprehensive index indicating cardiopulmonary function during exercise, O 2%P<60% should be selected to predict respiratory failure and evaluate indication of lung resection for patients with lung cancer.

关 键 词：心肺运动试验 肺癌 呼吸衰竭 手术 肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]