Brat Kristian, Tothova Zuzana, Merta Zdenek, Taskova Alice, Homolka Pavel, Vasakova Martina, Skrickova Jana, Sramek Vladimir, Olson Lyle J, Cundrle Ivan
Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Department of Respiratory Medicine, Thomayer Hospital, Prague, Czech Republic.
Ann Thorac Surg. 2016 Nov;102(5):1725-1730. doi: 10.1016/j.athoracsur.2016.05.070. Epub 2016 Aug 3.
Ventilatory efficiency (V˙e/V˙co slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙e/V˙co during exercise also exhibit an increased V˙e/V˙co ratio and a decreased end-tidal CO at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures.
Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant.
Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙e/V˙co ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙e/V˙co slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01).
Resting end-tidal CO may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.
通气效率（每分通气量与二氧化碳排出量斜率[V˙e/V˙co斜率]）已被证明可预测肺切除手术候选患者的发病率和死亡率。运动期间V˙e/V˙co增加的患者在静息时也表现出V˙e/V˙co比值增加和呼气末二氧化碳分压降低。本研究假设静息时的通气值可预测接受胸外科手术患者的呼吸并发症和死亡情况。
这项回顾性多中心研究的纳入标准为开胸手术和心肺运动试验作为常规术前评估的一部分。从病历（住院期间或术后前30天）评估呼吸并发症。为进行比较，采用了Student's t检验或Mann-Whitney U检验。进行逻辑回归和受试者工作特征分析以评估与呼吸并发症相关的测量指标。数据以均值±标准差表示；p<0.05被认为具有统计学意义。
研究了76名受试者。术后，56名（74%）患者出现呼吸并发症。术后有呼吸并发症的患者静息潮气量显著更低（0.8±0.3 vs 0.9±0.3L；p=0.03），静息呼气末二氧化碳分压更低（28.1±4.3 vs 31.5±4.2 mmHg；p<0.01），静息V˙e/V˙co比值更高（45.1±7.1 vs 41.0±6.4；p=0.02），以及V˙e/V˙co斜率更高（34.9±6.4 vs 31.2±4.3；p=0.01）。逻辑回归（校正年龄和性别）显示静息呼气末二氧化碳分压是呼吸并发症的最佳预测指标（比值比：1.21；95%置信区间：1.06至1.39；曲线下面积：0.77；p=0.01）。
静息呼气末二氧化碳分压可能识别出胸外科手术术后呼吸并发症风险增加的患者。
