Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Thorac Cardiovasc Surg. 2010 Jul;140(1):26-31. doi: 10.1016/j.jtcvs.2009.11.021. Epub 2010 Feb 4.
This study aims to establish the preoperative risk factors in the development of acute respiratory distress syndrome (ARDS) and early mortality after pneumonectomy for lung cancer and to examine the influence of reduced pulmonary perfusion on outcomes.
Between 1994 and 2009, of 425 patients who underwent simple pneumonectomy for primary lung cancer, 164 who were preoperatively evaluated with lung perfusion scanning formed the population of this study.
Of 30 (18.3%) patients who had major pulmonary complications, 17 (10.4%) progressed to ARDS, 15 of whom subsequently died. On multivariable logistic regression analyses, lower predicted postoperative forced expiratory volume in 1 second (ppo-FEV(1); relative risk of 0.93 [P = .020] for ARDS and 0.94 [P = .027] for mortality) and greater perfusion fraction of resected lung (relative risk of 1.10 [P = .003] for ARDS and 1.09 [P = .002] for mortality) were found to be independent factors associated with ARDS and early mortality. With a cut-off value of 35% for perfusion fraction of resected lung, patients with a perfusion fraction of greater than 35% had a greater incidence of ARDS (17.3% vs 3.3%, P = .005) and early mortality (19.8% vs 6.0%, P = .010) than those with a perfusion fraction of 35% or less.
Patients with a low ppo-FEV(1), a high perfusion fraction of resected lung, or both had a higher incidence of ARDS and early mortality after pneumonectomy. Therefore, although the ppo-FEV(1) appears to be within an acceptable limit for pneumonectomy, much attention should be given to patients with a high perfusion fraction of resected lung.
本研究旨在确定肺癌全肺切除术后急性呼吸窘迫综合征（ARDS）发展和早期死亡的术前危险因素，并探讨肺灌注减少对结局的影响。
1994 年至 2009 年间，425 例接受单纯肺癌全肺切除术的患者中，有 164 例患者术前接受了肺灌注扫描，构成了本研究的人群。
在 30 例（18.3%）发生重大肺部并发症的患者中，有 17 例（10.4%）进展为 ARDS，其中 15 例随后死亡。多变量逻辑回归分析显示，较低的预测术后第 1 秒用力呼气量（ppo-FEV1）（ARDS 的相对风险为 0.93[P=0.020]，死亡率为 0.94[P=0.027]）和较大的切除肺的灌注分数（ARDS 的相对风险为 1.10[P=0.003]，死亡率为 1.09[P=0.002]）是与 ARDS 和早期死亡率相关的独立因素。以切除肺的灌注分数 35%为截断值，灌注分数大于 35%的患者 ARDS 发生率（17.3% vs 3.3%，P=0.005）和早期死亡率（19.8% vs 6.0%，P=0.010）均高于灌注分数为 35%或更低的患者。
ppo-FEV1 低、切除肺的灌注分数高或两者兼有，患者全肺切除术后 ARDS 和早期死亡率较高。因此，尽管 ppo-FEV1 似乎在全肺切除术的可接受范围内，但应高度关注切除肺的高灌注分数患者。
