食管癌手术前肺功能试验与术后急性呼吸窘迫综合征的相关性

背景与目的：急性呼吸窘迫综合征（ARDS,acute respiratory distress syndrome）是食管癌手术后的一严重并发症,死亡率高。术前肺功能状况极大地影响医师对患者治疗方案的选择及预后的判断．而二者之间的相关性国内外报道较少,本研究旨在探讨食管癌术前传统肺功能试验与术后发生ARDS的相关性,为临床诊断与治疗提供依据。方法：回顾性分析我院2000～2002年的1488例行开胸手术治疗的食管癌患者术前传统肺功能试验的三个主要指标：第一秒用力呼气量占预计值百分比（FEV1％）,第一秒用力呼气量与用力肺活量比值（FEV1／FVC）％,最大通气量占预计值百分比（MVV％）及其它因素如年龄、性别、术式、术前心功能、早期加强监护治疗等与术后发生ARDS的关系。结果：1488例患者中,49例术后发生ARDS。FEV1％、（FEV1／FVC）％、MVV％、年龄交互作用后与术后ARDS的发生明显正相关（P值分别为0．001,0．005,0．048）;术前重度肺功能受损的49例患者中,术后随即入ICU32例,发生ARDS2例,ARDS发生率6．2％,术后回病房17例中发生ARDS5例,ARDS发生率29．4％。术后早期加强监护治疗能明显降低ARDS发生（P〈0．05）。结论：传统肺功能试验与开胸术后ARDS的发生有一定相关性,术后早期加强监护治疗是预防术后ARDS的重要手段。

Correlations of preoperative pulmonary function tests for esophageal cancer to postoperative acute respiratory distress syndrome

BACKGROUND & OBJECTIVE: Acute respiratory distress syndrome (ARDS), a serious postoperative complication of esophageal cancer, has a high mortality rate. Preoperative pulmonary function affects treatment project selection and prognosis prediction. The correlation of preoperative pulmonary function of esophageal cancer to postoperative ARDS has seldom been reported. This study was to analyze their correlation to serve for clinical medicine. METHODS: Clinical data of 1 488 esophageal cancer patients, received esophagectomy from 2000 to 2002 in our hospital, were retrospectively reviewed. The correlations of postoperative ARDS to 3 traditional parameters in pulmonary function test, including forced expiratory volume in the first one second (FEV1%), the ratio of FEV1 to forced vital capacity (FEV1/FVC)% and maximal voluntary ventilation (MVV%), and other factors, such as age, sex, operation pattern, preoperative cardiac function, early postoperative intensive care, were analyzed. RESULTS: Of the 1 488 patientss, 49 suffered postoperative ARDS. The occurrence of ARDS was negatively related to the interaction of FEV1%, (FEV1/FVC)%, MVV% and age (P=0.001, P=0.005, P=0.048). Of the 49 patients suffered severe preoperative lung function damage, 32 received intensive care right after operation, of whom 2 (6.2%) had ARDS; 5 (29.4%) of the remaining 17 had ARDS. Early postoperative intensive care significantly decreased the occurrence of ARDS (P<0.05). CONCLUSIONS: Traditional pulmonary function test have some correlations to postoperative ARDS. Early intensive care is important to prevent ARDS after operation.