肺癌左全肺切除术后心肺并发症的发生与术前肺功能指标检测及相关性分析

发布时间：2018-06-20 04:19

本文选题：肺癌 + 全肺切除　；参考：《天津医科大学》2015年硕士论文

【摘要】：目的:目前,肺癌临床手术切除后,心肺并发症(postoperative cardiopulmonary complication,PCC)的发病率较高,这些并发症,重者危及患者的生命,轻者也会影响患者的生存质量。为此,对于肺癌术后并发症的预防在临床肺癌手术治疗中具有重要的意义。如果能通过对肺癌患者术前肺通气功能和脉冲振荡(IOS)检测,评估、预测术后并发症的发生,则可通过调整手术方案和术中、术后用药,加强围手术期的护理,达到降低术后心肺并发症发生的目的。因此本研究分析了术前肺功能各指标与术后并发症发生的相关性,拟通过肺癌患者术前肺通气功能和脉冲振荡(IOS)检测指标,评估、预测术后并发症的发生风险。方法:(1)收集2008年1月至2010年12月200例施行左全肺切除手术的肺癌患者临床资料,根据患者术后1月内有无发生心肺并发症分为PCC组和无PCC组,分析术前正常、轻度、中度及重度肺功能减低对术后并发症发生的影响。(2)收集2012年1月至2012年12月行左全肺切除术的肺癌患者临床资料100例,其中术后出现呼吸衰竭并发症50例,未出现并发症50例。比较出现呼衰和无呼衰患者术前IOS检测各项指标的差异性;比较中心型肺癌与周围型肺癌术前IOS检测各项指标的差异性。(3)对200例肺癌患者的FEV1%、MVV%参数按3:1比例和50例肺癌患者IOS各参数按4:1比例,应用BP神经网络方法对术后并发症的发生进行了预测。结果:(1)200例患者中正常、轻度、中度及重度肺功能减低各35、45、98、22例,术后1月内PCC发生率分别为28.6%、53.3%、60.2%、77.3%,与正常组相比,差异均具有统计学意义(P0.05)。进一步分析显示:当FEV1%或MVV%单独轻度减低时,患者术后PCC的发生率分别为40%、35.29%,与正常组相比,差异无统计学意义(P0.05);而当FEV1%和MVV%同时轻度减低时,PCC的发生率为78.57%,差异具有显著性(P0.01)。当FEV1%或MVV%单独、同时中度减低时,患者术后PCC的发生率分别为52.63%、55.55%、69.04%,,与正常相比,差异有统计学意义(P≤0.05);当FEV1%或MVV%单独重度度减低时,由于样本量过小,无法进行统计学分析;而当FEV1%和MVV%同时重度减低时,PCC的发生率为89.47%,与正常相比,差异性非常显著(P0.01)。(2)呼衰组与非呼衰组术前IOS各项检测指标均有显著性差异(P0.05);中央型肺癌组与周围型肺癌组比较,除R20无显著性差异外,其它指标具有显著性差异。(3)200例患者FEV1%、MVV%建立的模型中,拟合率为94.37%,预测精度达90%以上,平均误差为0.023;50例患者IOS各参数建立的模型中,拟合率为99.73%,预测精度达90%以上,平均误差为0.020。结论:(1)术前肺功能状态直接影响术后并发症的发生,肺功能下降是术后并发症发生的危险因素。随着肺功能的进一步下降,其并发症发生率呈上升趋势,各下降组与正常组相比P0.05,且差异的显著性增加。FEV1%、MVV%其中一项单独轻度减低与正常组相比,对并发症的发生无显著影响,当FEV1%及MVV%同时轻度减低是肺癌左全切术后PCC发生的危险因素,应加强围手术期管理,降低PCC的发生。FEV1%、MVV%其中一项中度减低,都会影响术后并发症的发生,若两者同时中、重度减低,则术后发生并发症的可能性更大。因此术前肺通气功能检测指标FEV1%、MVV%的降低是影响肺癌左全肺切除术后并发症发生的危险因素,且降低程度越大,并发症发生的风险越高。(2)肺癌术前呼吸阻抗IOS检测指标有助于评估左全肺切除术后呼吸衰竭并发症的发生风险性,对手术适应证的评估起到重要作用。(3)在本研究中,肺通气功能参数与脉冲振荡肺功能参数建立的BP神经网络预测术后并发症的发生是可行的,但因样本量有限,其应用有待进一步研究。
[Abstract]:Objective: at present, the incidence of postoperative cardiopulmonary complication (PCC) is higher after surgical resection of lung cancer. These complications will endanger the life of the patients, and the light will also affect the quality of life of the patients. Therefore, the prevention of postoperative complications of lung cancer is of great importance in the clinical treatment of lung cancer. If the preoperative pulmonary ventilation function and pulse oscillation (IOS) can be detected, the postoperative complications can be predicted and the postoperative complications can be predicted, and the perioperative care can be improved by adjusting the operation plan and intraoperative and postoperative medication to reduce the incidence of postoperative cardiopulmonary complications. The correlation between postoperative complications and postoperative pulmonary ventilation function and pulse oscillation (IOS) was used to assess and predict the risk of postoperative complications. Methods: (1) 200 cases of lung cancer patients with left total pneumonectomy from January 2008 to December 2010 were collected. The pulmonary complications were divided into PCC group and no PCC group. The effect of normal, mild, moderate and severe pulmonary dysfunction on postoperative complications was analyzed. (2) 100 cases of lung cancer patients were collected from January 2012 to December 2012, including 50 cases of postoperative complications of respiratory failure and 50 cases without complications. The difference between the preoperative IOS detection indexes of patients with respiratory failure and non respiratory failure, and the difference between the indexes of IOS detection before operation for central lung cancer and peripheral lung cancer. (3) for the FEV1% of 200 cases of lung cancer, the MVV% parameters were proportional to the 3:1 ratio and the IOS parameters of 50 cases of lung cancer, and the BP neural network method was applied to the postoperative complications. Results: (1) in 200 patients with normal, mild, moderate and severe pulmonary dysfunction, the incidence of PCC in January was 28.6%, 53.3%, 60.2%, 77.3%, respectively. The difference was statistically significant (P0.05) compared with the normal group (P0.05). Further analysis showed that when FEV1% or MVV% was slightly reduced, the occurrence of PCC in patients after operation was observed. The rates were 40% and 35.29% respectively, compared with the normal group, the difference was not statistically significant (P0.05), while the incidence of PCC was 78.57% when FEV1% and MVV% decreased at the same time, and the difference was significant (P0.01). When FEV1% or MVV% alone, and moderate reduction, the incidence of postoperative PCC was 52.63%, 55.55%, 69.04%, respectively. The study significance (P < 0.05); when the FEV1% or MVV% individual severity decreased, there was no statistical analysis due to the small sample size, while the incidence of PCC was 89.47% when FEV1% and MVV% were severely reduced (P0.01). (2) there were significant differences between the pre operation IOS of the paging and non respiratory failure groups (2) P0.05): compared with the peripheral lung cancer group, the central lung cancer group and the peripheral lung cancer group had no significant difference. (3) in the 200 patients with FEV1% and MVV%, the fitting rate was 94.37%, the prediction accuracy was more than 90% and the average error was 0.023. The fitting rate of the IOS parameters in the 50 patients was 99.73%, and the prediction accuracy was 99.73%. Up to 90%, the average error was 0.020. conclusion: (1) the preoperative pulmonary functional status directly affected the postoperative complications, and the decrease of lung function was the risk factor for postoperative complications. With the further decline of the lung function, the incidence of complications increased, and the decrease group was compared with the normal group P0.05, and the difference was significantly increased by.FEV1%, M A single mild reduction in VV% has no significant effect on the occurrence of complications compared with the normal group. When FEV1% and MVV% are reduced at the same time as a risk factor for PCC after left total left lung resection of lung cancer, perioperative management should be strengthened to reduce the incidence of.FEV1% in PCC, and a moderate reduction in MVV% will affect the occurrence of postoperative complications, if both of them may affect the incidence of postoperative complications. At the same time, severe reduction, the possibility of postoperative complications is more likely. Therefore, preoperative pulmonary ventilation function detection index FEV1%, MVV% decrease is the risk factor for the complications after lung cancer left total pneumonectomy, and the greater the degree of reduction, the higher the risk of complications. (2) preoperative respiratory impedance IOS detection index of lung cancer is helpful for evaluation. It is important to estimate the risk of complications of respiratory failure after left total pneumonectomy and play an important role in the evaluation of surgical indications. (3) in this study, the BP neural network of pulmonary ventilation function parameters and pulse oscillatory pulmonary function parameters is feasible to predict the occurrence of postoperative complications, but its application remains to be further studied because of the limited sample size.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

【参考文献】