Mao You-sheng, He Jie, Yan Shao-ping, Cheng Gui-yu, Sun Ke-lin, Liu Xiang-yang, Fang De-kang, Li Jian, Wang Yong-gang, Huang Jin-feng
Department of Thoracic Surgical Oncology, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Zhong Liu Za Zhi. 2012 Jan;34(1):51-6.
To evaluate and compare the value of cardiopulmonary exercise test and conventional pulmonary function tests in the prediction of postoperative cardiopulmonary complications in high risk patients with chest malignant tumors.
From January 2006 to January 2009, 216 consecutive patients with thoracic malignant tumors underwent conventional pulmonary function tests (PFT, spirometry + DLCOsb for diffusion capacity) and cardiopulmonary exercise test (CPET) preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET were retrospectively analyzed using Chi-square test, independent sample t-test and logistic regression analysis. The P value < 0.05 was considered as statistically significant.
Of the 216 patients, 57 did not receive operation due to advanced stage diseases or poor cardiopulmonary function in most of them. The remaining 159 underwent different modes of operations. Thirty-six patients (22.6%) in this operated group had postoperative cardiopulmonary complications and 10 patients (6.3%) developed operation-related complications. Three patients (1.9%) died of the complications within 30 days postoperatively. The patients were stratified into groups based on V(O(2)) max/pred (≥ 65.0%, < 65.0%); V(O(2)) max×kg(-1)×min(-1) (≥ 20 ml, 15 - 19.9 ml, < 15 ml) and FEV1 (≥ 2.0 L, 1.2 - 1.99 L, < 1.2 L) according to the criteria in reported papers. There was statistically significant difference among these groups in the parameters (P < 0.05), the rates of postoperative cardiopulmonary complications were much higher in the groups with poor cardiopulmonary function (V(O(2)) max/pred < 65.0%; V(O(2)) max×kg(-1)×min(-1) < 15 ml or FEV1 < 1.2 L). It was shown by logistic regression analysis that postoperative cardiopulmonary complications were significantly correlated with age, associated diseases, poor results of PFT or CPET, operation modes and operation-related complications.
FEV1 in spirometry, V(O(2)) max×kg(-1)×min(-1) and V(O(2)) max/pred in cardiopulmonary exercise test can be used to stratify the patients' cardiopulmonary function status and is correlated well with FEV1. V(O(2)) max×kg(-1)×min(-1) is the best parameter among these three parameters to predict the risk of postoperative cardiopulmonary complications in patients with chest malignant tumors and borderline cardiopulmonary function.
评估和比较心肺运动试验与传统肺功能测试在预测胸部恶性肿瘤高危患者术后心肺并发症方面的价值。
2006年1月至2009年1月，216例连续的胸部恶性肿瘤患者术前接受了传统肺功能测试（PFT，肺活量测定 + 用于弥散功能的一氧化碳单次呼吸弥散量）和心肺运动试验（CPET）。采用卡方检验、独立样本t检验和逻辑回归分析对术后心肺并发症与PFT和CPET参数的相关性进行回顾性分析。P值<0.05被认为具有统计学意义。
216例患者中，57例因疾病晚期或大多数患者心肺功能差而未接受手术。其余159例接受了不同方式的手术。该手术组中有36例患者（22.6%）发生了术后心肺并发症，10例患者（6.3%）出现了与手术相关的并发症。3例患者（1.9%）术后30天内死于并发症。根据文献报道的标准，将患者按最大摄氧量/预计值（≥65.0%，<65.0%）、最大摄氧量×体重⁻¹×分钟⁻¹（≥20 ml，15 - 19.9 ml，<15 ml）和第一秒用力呼气容积（≥2.0 L，1.2 - 1.99 L，<1.2 L）进行分组。这些组在参数方面存在统计学显著差异（P<0.05），心肺功能差的组（最大摄氧量/预计值<65.0%；最大摄氧量×体重⁻¹×分钟⁻¹<15 ml或第一秒用力呼气容积<1.2 L）术后心肺并发症发生率要高得多。逻辑回归分析表明，术后心肺并发症与年龄、相关疾病、PFT或CPET结果差、手术方式及与手术相关的并发症显著相关。
肺活量测定中的第一秒用力呼气容积、心肺运动试验中的最大摄氧量×体重⁻¹×分钟⁻¹和最大摄氧量/预计值可用于对患者的心肺功能状态进行分层，且与第一秒用力呼气容积相关性良好。最大摄氧量×体重⁻¹×分钟⁻¹是这三个参数中预测胸部恶性肿瘤且心肺功能临界患者术后心肺并发症风险的最佳参数。
