肺癌患者术前呼气峰流速可以预测肺叶切除术后肺部并发症吗?

摘要

背景与目的 术后肺部并发症(postoperative pulmonary complications,PPCs)尤其是术后肺炎(postoperative pneumonia,POP)的发生,直接影响肺癌患者术后的快速恢复.呼气峰流速(peak expiratory flow,PEF)反映气道通畅性和咳嗽效率,咳嗽能力不足可能和术后肺部并发症有关.本研究旨在探讨术前PEF能否预测肺癌患者术后肺部并发症.方法 回顾性分析2014年1月-2015年12月四川大学华西医院胸外科单个医疗组433例肺癌手术治疗的患者,分析术前PEF及术后肺部感染、肺不张、肺持续性漏气等肺部并发症,并记录相关临床资料.结果 术前PEF值在并发症组(280.93±88.99) L/min显著低于无并发症组(358.38±93.69)L/min (P＜0.001);Logistic回归分析显示术前PEF值和手术时间是PPCs的独立危险因素;术前PEF阈值为320 L/min是预测PPCs发生的最佳临界值(AUC=0.706,95％CI:0.661-0.749),肺部并发症发生率PEF≤320 L/min组(26.6％)显著高于PEF＞320L/min组(9.4％)(P＜0.00l).结论 肺癌患者术前PEF值和术后PPCs发生有一定相关性,有可能作为预测PPCs发生的指标.%Background and objective Postoperative pulmonary complications (PPCs),especially postoperative pneumonia (POP),directly affect the rapid recovery of lung cancer patients after surgery.Peak expiratory flow (PEF) can reflect airway patency and cough efficiency.Moreover,cough impairment may lead to accumulation of pulmonary secretions which can increase the risk of PPCs.The aim of this study is to investigate the effect of preoperative PEF on PPCs in patients with lung cancer.Methods Retrospective research was conducted on 433 lung cancer patients who underwent lobectomy at the West China Hospital of Sichuan University from January 2014 to December 2015.The associations between preoperative PEF and PPCs were analyzed based on patients' basic characteristics and clinical data in hospital.Results Preoperative PEF value in PPCs group (280.93±88.99) L/min was significantly lower than that in non-PPCs group (358.38±93.69) L/min (P＜0.001).According to the binary logistics regression analysis,PEF and operative time were independent risk factors for PPCs.Further,ROC curve showed that PEF=320 L/min was the cut-off value for predicting the occurrence of PPCs (AUC=0.706,95％CI:0.661-0.749).The incidence of PPCs in PEF≤320 L/min group (26.6％) was significantly higher than that in PEF＞320 L/min group (9.4％)(P＜0.001).Conclusion Preoperative PEF and PPCs are correlated,and PEF maybe used as a predictor of PPCs.