肺功能检查和血气分析在预估胸腔镜肺切除术后并发症中的价值

摘要

目的 探讨术前肺功能及血气分析对肺切除患者术后并发症情况发生的预测作用及其临床价值.方法 回顾分析某院2016年10月-2017年8月行胸腔镜下肺切除术的298例患者,比较术前肺功能及血气指标与术后并发症、住院日等的相关性.根据肺通气功能,有无并发症,以及术前合并症分组,比较肺功能,血气指标以及合并症对术后情况的影响及其相关性.结果 298例患者中总的术后并发症发生率为23.15%.血气指标PaCO2异常组和正常组术后并发症的差异无统计学意义,肺功能指标与血气指标也均缺乏相关性,FEV1正常组在术后并发症和术后住院天数方面均少于FEV1异常组,FEV1/FVC则低于无并发症组.肺功能指标VC,FVC,MVV,FEV1,DLCO,ppoFEV1与术后住院日均有负相关性.结论 血气指标不能替代肺弥散功能进行肺切除术前评估;无论通气功能如何都应该进行肺弥散功能的检查;术前肺功能差的患者术后并发症发生几率更大,住院时间更长.%Objective To investigate the clinical value of preoperative pulmonary function and blood gas analysis on predicting the incidence of postoperative cardiopulmonary complications(PCC)in lung resection patients. Methods Total of 298 cases of video-assisted thoracic surgery for lung resection patients were collected for retrospective analysis of PCC(postoperative cardiopulmonary complications). Patients are divided into groups according to PCC,parameters of ventilator function(FEV1,FEV1/FVC)and preoperative comorbidities,so as to compare the difference of lung function,blood gas analysis and postoperative conditions . The correlation of PCC with pulmonary function was also analyzed.Results Among 298 patients,postoperative complications were occurred in 69 cases(23.15%). PaCO2and PaO2 did not have correlation with pulmonary function test. Abnormal FEV1 group suffered from more PCC and longer postoperative hospitalization than normal FEV1 group. PCC group and non-PCC group had statistical difference in age,postoperative hospitalization and FEV1/FVC (P＜0.05).Correlation analysis showed that preoperative lung function test including VC,FVC,MVV,FEV1,DLCO,ppoFEV1 negatively correlated with postoperative hospitalization.Conclusion Blood gas analysis cannot substitute pulmonary function test in evaluation of lung resection,and lung diffusion capacity test should be done regardless of lung ventilation function. Preoperative commodities indicate postoperative cardiopulmonary complications occurrence and prolonged postoperative hospitalization.