登楼试验预测肺叶切除术后心肺并发症的研究

目的:评价登楼试验预测肺癌患者肺叶切除术后心肺并发症的作用。方法:将需行肺叶切除术的418例肺癌患者行肺功能检查后随机分成两组,P组中ppoFEV1%>30%者205例行手术治疗,S组行登楼试验,于60s内可以登楼48级台阶、静息状态呼吸室内空气时SpO2>90%者200例经术前功能锻炼后行手术治疗,并将S组分为无并发症组和并发症组,对两组间的登楼试验结果进行比较。结果:405例患者接受手术,术后出现心肺并发症47例(11.6%),其中心律失常14例、心功能衰竭7例、心肌梗死1例、肺部感染14例、肺不张5例、肺动脉栓塞1例、呼吸衰竭5例(其中1例死亡)。P组出现心肺并发症25例(12.19%),S组出现并发症22例(11.00%),二组并发症发生率差异无统计学意义(P>0.05)。S组中的无并发症组和并发症组患者的ppoFEV1%、DLCO%、ΔHR差异有统计学意义,登楼时间和ΔSpO2差异无统计学意义。结论:登楼试验是一种简便、经济的预测肺癌患者肺叶切除术后心肺并发症的手段。

Role of stair climbing test in preoperative evaluation of patients with lung cancer being considered for resectional surgery

Objective To assess the role of stair climbing test in the preoperative evaluation of patients with lung cancer being considered for resectional surgery.Method Total 418 patients with lung cancer being considered lobectomy underwent spirometry testing,they were divided into two groups： group P and group S.For 205 patients whose ppoFEV1 % 30% in group P received lobectomy.Stair climbing test were performed in patients of group S,surgery were performed in 200 patients who can climb 48 steps （ one step is 0.145 m in height） in 60 s and with SpO2 90% ,their clinical states were observed.Patients of group S were divided into two groups： without postoperative cardiopulmonary complication and with postoperative cardiopulmonary complication,clinical characteristics and preoperative pulmonary function were compared between these two groups.Results For 47 of 405 patients （ 11.6% ） had cardiopulmonary complications： pneumonia （ n = 14） ,arrhythmia （ n = 14） ,cardiac failure （ n = 7） ,respiratory insufficiency （ n = 5） ,atelectasis （ n = 5） ,myocardial infarction （ n = 1） ,pulmonary embolism（ n = 1） .Postoperative cardiopulmonary complications occurred in 25 of 205 patients of group P,and 22 of 200 patients of group S had cardiopulmonary complications,no significant difference between two groups in postoperative morbidity （ P 0.05） .In group S,no significant differences in age,weight,FEV1 % ,MVV% ,VC% ,time of climbing stair test and ΔSpO2 （ difference in SpO2 between values at rest and at the end of exercise ） between the patients with complications and patients without complications （ P 0.05） .The patients without complications had a higher ppoFEV1 % ,DLCO% and lower ΔHR （ difference in HR between values at rest and at the end of exercise） ,compared to patients with complications.Conclusion Stair climbing test is a simple and economical means to evaluate patients with lung cancer.