呼吸阻抗预测肺癌病人术后呼吸衰竭的临床意义

目的 探讨呼吸阻抗在预测肺癌病人术后呼吸衰竭（呼衰）中的临床意义。方法 用脉冲震荡法测定176例行肺切除术、且能明确诊断是否合并术后呼衰的原发性肺癌病人的呼吸阻抗等指标。结果 （1）全肺切除术后呼衰组呼吸阻抗明显增高，与非呼衰组间差异有显著性（P＜0．01或0．05）。除5Hz时的弹性阻力实测值与预计值之差（X5）和周围阻力（Rp）外，肺叶切除术后呼衰组其余指标的测定结果与非呼衰组间差异有显著性（P＜0．05）。（2）Logistic回归分析显示，共振频率（Fres）＞15Hz、20Hz时粘性阻力（R20）＞150％与全肺切除术后呼衰的发生密切相关（P＜0．01或0．05）。R20＞140％与肺叶切除术后呼衰的发生密切相关（P＜0．05）。（3）Fres＞15Hz和R20＞150％预测全肺切除术后是否发生呼衰的敏感度、特异度、准确性接近或略高于FEV1．0＜60％。R20＞140％预测肺叶切除术后是否发生呼衰的敏感度、特异度、准确性与最大自主通气量（MVV％）＜50％相接近。结论 呼吸阻抗可以作为预测术后呼吸衰竭、评估手术适应证的重要指标。

The significance of respiratory impedance for prediction of post-operative respiratory failure in the patients with lung cancer

Objective: To study the clinic significance of respiratory impedance for prediction of post operative respiratory failure in the patients with lung cancer. Methods: Using Impulse Oscillometry, respiratory impedance were measured in 176 patients with lung cancer undergoing pneumonectomy or lobectomy. The patients were divided into post-operative respiratory failure and non post operative respiratory failure group, respectively. Results: For the patients who received pneumonectomy, the respiratory impedance in the group of respiratory failure was significantly higher than that in the group of non-respiratory failure (P<0 01 or 0.05). For the patients who received lobectomy, the respiratory impedance in the group of respiratory failure was higher than that in the group of non respiratory failure (P<0 05), except X5 and Rp. Logistic regression analysis showed that Fres>15?Hz, and R20>150% were correlated to post operative respiratory failure in pneumonectomy group (P<0 01 or 0 05), and R20>140% were correlated to post operative respiratory failure in lobectomy group (P<0 05). For pneumonectomy, the sensitivity, specificity and accuracy of Fres, R5, R20, and Rp to predict post operative respiratory failure were better than FEV 1.0 and MVV%. Conclusion: Respiratory impedance is an important index to predict post-operative respiratory failure in lung resection candidates.