A METHOD FOR PREDICTING POSTOPERATIVE LUNG-FUNCTION AND ITS RELATION TO POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH LUNG-CANCER
A METHOD FOR PREDICTING POSTOPERATIVE LUNG-FUNCTION AND ITS RELATION TO POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH LUNG-CANCER
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DOI：
10.1016/s0003-4975(10)62591-x
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发表时间：
1985-01-01
影响因子：
4.6
通讯作者：
KAWASHIMA, Y
中科院分区：
文献类型：
--
作者：
NAKAHARA, K;MONDEN, Y;KAWASHIMA, Y
用公式预测1例S(FEV1)患者术后用力呼气容积(FEV1)，公式为：术后FEV1=[1-(b-n)/(42-n)](术前FEV1)，其中n和b分别为切除肺叶阻塞亚段数和总亚段数。假设右上、中、下叶的b分别为6、4和12，左上叶和左下叶的b分别为10。梗阻亚段n为术前支气管镜和/或支气管镜检查所见。由预测值(X)与实测值(Y)的相关性得出的线性回归直线为y=0.850x+0.286.+-。0.296(标准误差)(N=52；r=0.821；P<；0.001)。对188例原发性肺癌患者的术后预计FEV1进行了计算。用上述回归方程对预测值进行修正，然后按S身高和性别(%FEV1(p，c))进行归一化。研究%FEV1(p，c)与手术风险的相关性。术后呼吸道并发症与%FEV1(p，c)呈负相关，当%FEV1(p，c)小于预计正常值的60%时，并发症发生率显著升高(P<；0.05)。在无并发症的老年患者(65岁及以上)中，%FEV1(p，c)为67.3。18.0%，为52.2。+-。有呼吸困难者占12.8%，+-者占53.3%。有循环并发症者占9.6%。有并发症组与无并发症组之间差异有统计学意义(P<；0.01)。在非老年组中，无并发症、呼吸系统并发症或循环并发症的患者之间无显著差异。该公式是预测老年肺癌患者术后肺功能的可靠方法，也是预测老年肺癌手术风险的指标。
The postoperative [postop] forced expiratory volume in 1 s (FEV1) was predicted with a formula based on the premise that the total number of subsegments was 42: postop FEV1 = [1- (b - n)/(42 - n)] (preop FEV1), where n and b are the number of obstructed subsegments and total subsegments, respectively, in the resected lobe. It was assumed that b was 6, 4 and 12 in the right upper, middle, and lower lobes, respectively, and 10 each in the left upper and the left lower lobes. The obstructed subsegments, n, were obtained from the findings on bronchography or bronchofiberscopy or both before operation. The linear regression line derived from the correlation between predicted (x) and measured (y) FEV1 was y = 0.850x + 0.286 .+-. 0.296 (standard error) (N = 52; r = 0.821; P < 0.001). The predicted postoperative FEV1 was calculated in 188 patients with primary lung cancer. The predicted values were corrected with the regression equation just mentioned and then normalized by the patient''s height and sex (%FEV1(p,c)). The correlation between %FEV1(p,c) and the surgical risk was studied. Postoperative respiratory complications were inversely related to %FEV1(p,c), and a significantly high incidence of complications (P < 0.05) was observed in those whose %FEV1(p,c) was less than 60% of predicted normal. In aged patients (65 yr old or more) without complications, %FEV1(p,c) was 67.3 .+-. 18.0%; it was 52.2 .+-. 12.8% in those with respiratory trouble and 53.3% .+-. 9.6% in those with circulatory complications. The difference between groups with and without complications was significant (P < 0.01). In the nonaged group, there were no significant differences among the patients with no complications, respiratory complications, or circulatory complications. This formula involving subsegments is a reliable method for predicting postoperative lung function and is a predictor of the surgical risk in aged patients with lung cancer.