Objective To explore the high risky factors leading to postoperative respiratory failure in patients with lung cancer and to evaluate the value of static lung function test.Methods Sixty - three lung cancer patients developing to postoperative respiratory failure admitted to our hospital from January 2007 to December 2011 were selected as study group, and 126 lung cancer patients without postoperative respiratory failure were selected as control group.The clinical indexes and results of static lung function test of the two groups were compared.The risk factors were analyzed by multivariable logistic regression.The results of static lung function test were expressed by the relative vessel percentage of measured value and expected value.Results Age, smoking history, combination with COPD , preoperative pulmonary function disorder, operative time, fluid input, rate of pneu-monectomy and incidence of severe complications significantly decreased in study group compared with control group ( P < 0.05 ), but sex, combination of diabetes, hypertension, coronary heart disease and site and length of tumor showed no statistically significant difference ( P > 0.05 ) .The vital volume ( VC% ), forced vital capacity ( FVC% ), forced expiratory volume in the first second ( FEV1% ), maximal voluntary ventilation ( MVV% ), forced expiratory flow at 25% of FVC has been exhaled ( FEF25% % ), forced expiratory flow at 50% of FVC has been exhaled ( FEF50% % ), peak expiratory flow ( PEF% ) and maximal mid -expiratory flow ( MMEF% ) significantly decreased in study group compared with control group ( P <0.05 ), but FEV1/ FVC% , FEV1/VC% and forced expiratory flow at 75% of FVC has been exhaled ( FEF75% % ) showed no statistically significant difference ( P > 0.05 ) .Multivariable logistic regression analysis was performed by taking respiratory failure as dependent variable and indexes with significant differences as independent variable.The result showed that age, preoperative pulmonary function disorder, operative fluid input, pneumonectomy and severe postoperative complications were significantly associated with incidence of postoperative respiratory failure.Conclusion Severe preoperative pulmonary function disorder, severe postoperative complications , total pneumonectomy, excessive operative fluid input and old age are risky factors leading to postoperative failure for patients with lung cancer.%目的 探讨肺癌患者术后发生呼吸功能衰竭的影响因素,分析静息肺功能检测的临床评估价值.方法 选取2007年1月-2011年12月我院收治的肺癌术后发生呼吸功能衰竭的患者63例为研究组,另随机抽取同期术后未发生呼吸功能衰竭的肺癌患者126例为对照组.统计两组患者各临床指标,采用多因素Logistic回归分析呼吸功能衰竭的影响因素.检测两组患者静息肺功能指标,取各项实测值和理论预期值的相对百分比表示.结果 研究组较对照组患者年龄、吸烟率、合并慢性阻塞性肺疾病(COPD)、术前肺功能程度、手术时间、术中液体输入量、切除范围及严重并发症发生率均降低,差异有统计学意义(P＜0.05);而两组的性别、合并糖尿病、高血压、冠心病及肿瘤部位、病灶长度比较,差异均无统计学意义(P＞0.05).研究组较对照组静息肺功能指标肺活量(VC%)、用力肺活量(FVC%)、第1秒用力呼气容积(FEV1%)、最大自主通气量(MVV%)、用力呼气25%肺活量瞬间流速(FEF25%%)、用力呼气50%肺活量瞬间流速(FEF50%%)、最大呼气流量(PEF%)和最大呼气中期流量(MMEF%)均降低,差异均有统计学意义(P＜0.05);而FEV1/FVC%、FEV1/VC%、用力呼气75%肺活量瞬间流速(FEF75%%)比较,差异均无统计学意义(P＞0.05).以呼吸功能衰竭为因变量,以单因素分析差异有统计学意义的指标为自变量,进行Logistic回归分析,结果显示,患者年龄、术前肺功能障碍、术中液体输入量、全肺切除和术后严重并发症进入回归模型.结论 高龄、术前肺功能障碍、术中液体输入量、全肺切除、严重并发症是肺癌患者术后发生呼吸功能衰竭的危险因素,静息肺功能指标可以评估呼吸功能情况.
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