Relationship of Carbon Monoxide Pulmonary Diffusing Capacity to Postoperative Cardiopulmonary Complications in Patients Undergoing Penumoenctomy

肺部一氧化碳擴散能力和全肺切除術後心肺併發症的關係

王正信(Jeng-Shing Wang)

《The Kaohsiung Journal of Medical Sciences》 19卷9期 (2003/09) Pp. 437-446

摘要

本篇回溯研究主要評估一氧化碳擴散能力預測全肺切除術後心肺併發症的發生。從1992年1月到1997年12月期間，共有151位因肺癌至加拿大溫哥華總醫院接受全肺切除術的患者。肺功能檢查完全根據標準技術在肺功能室進行，術後30天內的併發症分類為死亡、心血管、肺部和技術併發症。151位患者中，男性100位 (66%)、女性51位 (34%)平均年齡61歲。有73位 (48%)發生併發症，其中死亡8位 (5%)；心血管併發症50位 (33%)肺部併發症30位 (22%)和技術併發症22位 (15%)。兩個主要心血管併發症為心律不整和肺水腫，發生率分別為21%及13%，而有併發症的患者比無併發症的患者吸煙較多、住院較長、FEV1較低、FEV1/FVC較低、DLCO較低、DLCO/VA較低。DLCO在預估值70%為術後心肺併發症最佳預測指標，患者若DLCO預估值低於70%，併發症發生率為94%，相對的，患者若DLCO預估值高於70%，併發症發生率為27%（敏感性為62%，特異性為96%）。但是技術併發症和術前肺功能變數包括DLCO均不相關，患者若DLCO預估值高於70%，則全肺切除術後心肺併發症發生率較低，雖然心律不整是併發症的主要原因，肺水腫卻是死亡的主要原因。

關鍵字

擴散能力,術後併發症,術前評估

並列摘要

This retrospective analytic study evaluated whether abnormal diffusing capacity for carbon monoxide (DLCO) is a predictor of postoperative morbidity and mortality in patients undergoing pneumonectomy for lung cancer. The medical records of patients undergoing pneumonectomy at Vancouver General Hospital between January 1992 and December 1997 were reviewed. Postoperative complications occurring within 30 days of resection were classified into mortality, and cardiovascular, pulmonary, and technical complications. A total of 151 pneumonectomy cases were reviewed. There were 100 men (66%) and 51 women (34%) with a mean age of 61 years. Complications occurred in 73 patients (48%), including mortality in eight (5%), cardiovascular morbidity in 50 (33%), pulmonary morbidity in 30 (20%), and technical morbidity in 22 (15%). Arrhythmia (21%) and pulmonary edema (13%) were the two major cardiovascular complications. Patients with complications had a greater smoking history, a longer hospital stay, a lower forced expiratory volume in 1 second (FEV1), a lower FEV1/forced vital capacity (FVC) ratio, a lower DLCO, and a lower DLCO/alveolar volume (VA) ration than patients without complications. A DLCO of 70% predicted was the best functional predictor of postoperative complications, with a complication rate of 94% in patients with a DLCO of less than 70% predicted compared with 27% in patients with a DLCO of at least 70% predicted (sensitivity, 62%; specificity, 96%). However, technical morbidity was not related to preoperative lung function variables, including DLCO. Patients with a DLCO of at least 70% predicted had a low postpneumonectomy complication rate. Although cardiac arrhythmia was the major cause of morbidity, pulmonary edema was the major cause of mortality.

並列關鍵字

diffusing capacity, postoperative complications, preoperative assessment