重度肺功能减退的肺癌患者术前肺功能改善及手术并发症分析

目的:分析重度肺功能减退患者肺叶切除手术前肺功能改善情况,手术效果及术后并发症.方法:回顾性分析我院2002～2008年收治的35例重度肺功能减退患者术前处理后,肺功能指标FEV1和PaO2改善情况,并与同时期54例轻度或正常肺功能患者的手术效果和术后并发症进行比较.结果:重度肺功能减退组FEV1和PaO2分别从入院的(0.72±0.14)L.(64.28±6.93)mmHg增加为处理后的(1.06±0.20)L、(74.2±7.04)mmHg,P＜0.001;两组患者总住院天数分别为(25.32±2.31)d和(18.74±1.76)d,P＜0.001;术后呼吸机使用时间分别为(8.81±3.6)h和(3.05±0.90)h,P＜0.001;低氧血症、心律失常、肺部感染、住院期间死亡率和总并发症率分别为48.1%、29.6%、33.3%、14.8%、59.3%和18.5%、11.1%、18.5%、0、31.1%,P值分别为0.005、0.038、0.138、0.04和0.016.结论:对重度肺功能减退的肺癌患者术前积极改善肺功,可提高患者手术耐受,但对肺功能严重减低的患者施行肺叶切除时,术后发生心肺并发症的机率明显增加,术后死亡率较高.

Pre-operative pulmonary function improvements and post-operative complications of lung cancer patients with severely reduced pulmonary function

Objective：To compare the pulmonary function（PF）improvements of lung cancer patients with severely reduced PF before operation,and to analyze operative effects and operation related complications.Methods：35 lung cancer patients were processed to im-prove PF before operation between 2002 to 2008,and the effect was assessed by FEV1 and PaO2,and then the operative effect and com-plication were compared with contemporary 54 lung cancer patient with normal or minor reduced PF suffered to lobectomy.Results：The FEV1 and PaO2 increased from（0.72±0.14）L and（64.28±6.93）mmHg to（1.06±0.20）L and（74.2±7.04）mmHg respectively,and p-value was less than 0.001.The hospitalized days and ventilator-time were（25.32±2.31）d,（8.81±3.6）h and（18.74±1.76）d,（3.05±0.90）h respectively,and both p-value was less than 0.001.The incidences of hypoxemia,arrhythmia,pulmonary infection,postoperative mortality and total complications were 48.1%,29.6%,33.3%,14.8%,59.3% and 18.5%,11.1%,18.5%,0%,31.1%,p-value were 0.005,0.038,0.138,0.04 and 0.016 respectively.Conclusion：In the patients with severely reduced PF,though pulmonary function could be improved markedly be-fore operation,the operative related complications and mortality may be significantly higher than normal or minor reduced PF patients.