高原地区肺气肿指数对老年患者肺叶切除术后呼吸并发症的预测价值
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摘要
目的研究肺气肿指数(EI)对高原地区老年患者肺叶切除术后呼吸并发症的预测价值。方法收集我院2016年5月至2017年12月期间收治的行肺叶切除术的老年患者68例,年龄60-79岁。均于术前检测肺气肿指数(EI)及肺功能(PFT)指标,观察术后呼吸并发症并进行统计学分析。结果经多因素Lo-gistic回归分析,EI和DLCO的OR值分别是19. 51和19. 18(P <0. 01),提示EI和DLCO是术后呼吸并发症的独立预测因素。应用ROC曲线,并经MedCalc软件比较二者ROC曲线下面积(AUCs),EI大于DLCO(P=0. 0305 <0. 05),提示EI对术后呼吸并发症的预测更敏感。结论肺气肿指数(EI)是一项预测肺叶切除术后发生呼吸并发症的更加敏感的指标。
Objective To study the predictive value of EI for elderly patients underwent lobectomy at high altitude. Methods From May,2016 to November,2017,68 elderly patients were underwent lobectomy and observed postoperative pulmonary complications. They all were examined EI and PFT before operation. Results Through logistic multivariate analysis,EI and DLCO were independent risk predictive factors. Comparing the area under curve of ROC,EI was greater than DLCO. EI had more stronger association with postoperative complications. Conclusion EI can be regard as a more sensitive predictive factor for postoperative pulmonary complications.
Objective To study the predictive value of EI for elderly patients underwent lobectomy at high altitude. Methods From May,2016 to November,2017,68 elderly patients were underwent lobectomy and observed postoperative pulmonary complications. They all were examined EI and PFT before operation. Results Through logistic multivariate analysis,EI and DLCO were independent risk predictive factors. Comparing the area under curve of ROC,EI was greater than DLCO. EI had more stronger association with postoperative complications. Conclusion EI can be regard as a more sensitive predictive factor for postoperative pulmonary complications.
引文
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[5]管宇,张铁峰,范丽,等.慢性阻塞性肺疾病患者256i CT肺实质灌注成像的定量评估及与肺功能、气肿指数的相关性研究[J].实用放射学杂志,2013,29(6):902-905,927.
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[10]牛朋影,蔡中,哈若水.多层螺旋CT肺气肿指数评估慢性阻塞性肺疾病的肺叶功能[J].中国医学影像学杂志,2013,21(5):353-356.
[11]BRUNELLI A,KIM A W,BERGER K I,et al.Physiologic evaluation of the patient with lung cancer being considered for resectional surgery:diagnosis and management of lung cancer,3rd ed:American college of chest physicians evidence-based clinical practice guidelines[J].Chest,2013,143(S5):e166S-e190S.
[12]MOHAMED HOESEIN F A,DE JONG P A,LAMMERS J W,et al.Contribution of CT quantified emphysema,air trapping and airway wall thickness on pulmonary function in male smokers with and without COPD[J].COPD,2014,11(5):503-509.
[13]GU S,LEADER J,ZHENG B,et al.Direct assessment of lung function in COPD using CT densitometric measures[J].Physiol Meas,2014,35(5):833-845.
[2]张彦博,汪源,刘学良,等.人与高原:青海高原医学研究[M].西宁:青海人民出版社,1996:301-306.
[3]BERRY M F,VILLAMIZAR-ORTIZ N R,TONG B C,et al.Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy[J].Ann Thorac Surg,2010,89(4):1044-1052.
[4]张攀,于化鹏,樊惠珍,等.高分辨率CT肺气肿定量与慢性阻塞性肺疾病严重程度的相关性[J].实用医学杂志,2016,32(13):2187-2190.
[5]管宇,张铁峰,范丽,等.慢性阻塞性肺疾病患者256i CT肺实质灌注成像的定量评估及与肺功能、气肿指数的相关性研究[J].实用放射学杂志,2013,29(6):902-905,927.
[6]HERSH C P,WASHKO G R,ESTPAR R S,et al.Paired inspiratory-expiratory chest CT scans to assess for small airways disease in COPD[J].Respir Res,2013,14(1):42.
[7]KIM S S,SEO J B,KIM N,et al.Improved correlation between CTemphysema quantification and pulmonary function test by density correction of volumetric CT data based on air and aortic density[J].Eur J Radiol,2012,83(1):57-63.
[8]WANG J S,CHERNG J M,PERNG D S,et al.High-resolution computed tomography in assessment of patients with emphysema[J].Respir Care,2013,58(4):614-622.
[9]夏艺,管宇,范丽,等.高分辨率CT容积定量技术在慢性阻塞性肺疾病中的应用研究[J].医学影像学杂志,2013,23(8):1219-1222.
[10]牛朋影,蔡中,哈若水.多层螺旋CT肺气肿指数评估慢性阻塞性肺疾病的肺叶功能[J].中国医学影像学杂志,2013,21(5):353-356.
[11]BRUNELLI A,KIM A W,BERGER K I,et al.Physiologic evaluation of the patient with lung cancer being considered for resectional surgery:diagnosis and management of lung cancer,3rd ed:American college of chest physicians evidence-based clinical practice guidelines[J].Chest,2013,143(S5):e166S-e190S.
[12]MOHAMED HOESEIN F A,DE JONG P A,LAMMERS J W,et al.Contribution of CT quantified emphysema,air trapping and airway wall thickness on pulmonary function in male smokers with and without COPD[J].COPD,2014,11(5):503-509.
[13]GU S,LEADER J,ZHENG B,et al.Direct assessment of lung function in COPD using CT densitometric measures[J].Physiol Meas,2014,35(5):833-845.