肺癌患者弥散功能特点及临床意义探讨

目的：探讨肺癌患者弥散功能特点及临床意义。方法：用复重呼吸法对138例原发性肺癌患者的弥散功能进行测定。结果：弥散量（DLCOrb）、校正弥散量（DLCOrbc）在不同类型和不同程度及通气功能障碍的组间及不同大体类型间均无显著性差异（P＞0．05），但是肺通气功能正常的肺癌患者弥散系数（DLCOrb／VA）略降低，限制型组校正弥散系数（DLCOc／VA）降低（P＜0．01），阻塞型组和混合型组弥散系数降低（P＜0．05）。肺通气功能轻度减退和显著减组的肺癌患者校正弥散系数降低（P＜0.05).中心型肺癌患者校正弥散系数降低且与周围型组间有显著性差异（P＜0．01）。术后呼衰组弥散量、校正弥散系数低于无呼衰组，有显著性差异（P＜0．05）。校正弥散系数＜80％和弥散系数＜70％预测术后呼衰诊断正确率和诊断指数较高。结论：肺癌患者存在弥散功能减退，主要表现在弥散系数和校正弥散量的异常，肺癌的大体类型和患者的肺通气功能状态对肺弥散功能均有影响，应选择校正弥散系数＜80％和弥散系数＜70％预测术后呼衰。

Characteristics and clinical significance of diffusing capacity in the patients with lung cancer

Objective To explore the characteristics and clinical significance of diffusing capacity in the patients with lung cancer. Methods The pulmonary diffusing capacity for carbon monoxide (D LCO) was measured with the rebreathing method in 138 patients with primary lung cancer, and 86 were performed pulmonary resection. Results There was no significant difference in D LCOrb and D LCOrbc between the groups with different histological type and degree of ventilation impairment and general type (P>0.05). D LCOrb/V A mildly decreased in the patients whose lung ventilation function was normal. D LCOc/V A decreased in the patients with restrictive ventilation dysfunction (P<0.01), and D LCOrb/V A decreased in the patients with obstructive and mixed ventilation dysfuncion (P<0.05). D LCOc/V A decreased in the patients with light and obvious lung dysfunction (P<0.05). D LCOc/V A in the patients with central lung cancer was lower than that in the peripheral ones (P<0.01). D LCOc/V A and D LCOrb in the group with postoperative respiratory failure were lower than that in the group without respiratory failure (P<0.05). When D LCOc/V A of less than 80% and D LCOrb/V A of less than 70% were used to predict the postoperative respiratory failure, the correct ratios of dignosis and the diagnostic indexes were high. Conclusion The diffusing capacity decreases in the patients with lung cancer, and the main manifestation is the abnormal D LCOrb/V A and D LCOc/V A. The general type of lung cancer and the degree of pulmonary dysfunction may influence the diffusing function of the patients. D LCOc/V A of less than 80% and D LCOrb/V A of less than 70% should be selected for predicting postoperative respiratory failure.