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目的 探讨肺癌术后发生呼吸功能衰竭的高危因素。方法 总结肺癌术后呼衰患者 3 6例 ,并以同期手术未发生术后呼衰的 72例肺癌患者作对照 ,用 χ2 检验、分层 χ2 检验和Logistic回归分析可能导致呼衰的高危因素。结果 呼衰组的最大通气量 (MVV)、残气容积 /肺总量比值 (RV/TLC)、一秒钟用力呼气容积 (FEV1 )、通气储量百分比 (BR)、2 5 %肺活量最大呼气流量 (V2 5 )、最大呼气中段流量(MMEF) ,以及肺一氧化碳弥散量 (DLCO)均显著低于对照组 (P均 <0 .0 5 )。呼衰组术后引流量及术日(含术中 )静脉晶体入量和输血量显著高于对照组 (P <0 .0 5 )。按肺功能好坏分层后 ,袖式肺叶切除、肺叶切除的呼衰发生可能性均低于全肺切除。结论 中小气道重度阻塞、肺换气功能下降、围术期大量输血输液是术后发生呼衰的高危因素 ,支气管及支气管肺动脉袖式成形肺叶切除可以在达到根治的前提下有效避免呼衰发生
Objective To explore the risk factors for respiratory failure after lung cancer surgery. Methods A total of 36 patients with respiratory failure after lung cancer surgery were enrolled, and 72 patients with lung cancer who did not experience postoperative respiratory failure during the same period were used as controls. χ2 test, stratification χ2 test and logistic regression analysis were used to analyze the risk factors of respiratory failure. RESULTS: The maximum ventilation volume (MVV), residual volume/lung volume ratio (RV/TLC), forced expiratory volume in one second (FEV1), ventilation reserve percentage (BR), and 25% lung volume in the respiratory failure group Air flow (V2 5), maximum mid-expiratory flow (MMEF), and lung carbon monoxide diffusion (DLCO) were all significantly lower than those in the control group (P all < 0.05). The postoperative drainage volume and intraoperative (including intraoperative) intravenous crystal volume and blood transfusion volume in the respiratory failure group were significantly higher than those in the control group (P < 0.05). Stratified pulmonary lobectomy and lobectomy were less likely to occur after pulmonary stratification. Conclusion Severe obstruction of the middle and small airways, decreased lung ventilation function, and large blood transfusion during perioperative period are risk factors for postoperative respiratory failure. Sleeve-shaped lobectomy of bronchial and bronchial pulmonary arteries can effectively prevent respiratory failure on the premise of achieving radical cure.