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目的 探讨呼吸阻抗在预测肺癌病人术后呼吸衰竭 (呼衰 )中的临床意义。方法 用脉冲震荡法测定 176例行肺切除术、且能明确诊断是否合并术后呼衰的原发性肺癌病人的呼吸阻抗等指标。结果 (1)全肺切除术后呼衰组呼吸阻抗明显增高 ,与非呼衰组间差异有显著性 (P <0 0 1或 0 0 5 )。除5Hz时的弹性阻力实测值与预计值之差 (X5 )和周围阻力 (Rp)外 ,肺叶切除术后呼衰组其余指标的测定结果与非呼衰组间差异有显著性 (P <0 0 5 )。 (2 )Logistic回归分析显示 ,共振频率 (Fres) >15Hz、2 0Hz时粘性阻力 (R2 0 ) >15 0 %与全肺切除术后呼衰的发生密切相关 (P <0 0 1或 0 0 5 )。R2 0 >140 %与肺叶切除术后呼衰的发生密切相关 (P <0 0 5 )。 (3)Fres>15Hz和R2 0 >15 0 %预测全肺切除术后是否发生呼衰的敏感度、特异度、准确性接近或略高于FEV1 .0 <6 0 %。R2 0 >140 %预测肺叶切除术后是否发生呼衰的敏感度、特异度、准确性与最大自主通气量 (MVV % ) <5 0 %相接近。结论 呼吸阻抗可以作为预测术后呼吸衰竭、评估手术适应证的重要指标。
Objective To investigate the clinical significance of respiration impedance in predicting postoperative respiratory failure (respiratory failure) in patients with lung cancer. Methods Pulsed shock method was used to measure the respiration impedance and other indexes of 176 patients with primary lung cancer who underwent pneumonectomy. Results (1) Respiratory impedance was significantly higher in the respiratory failure group after pneumonectomy than in non-respiratory failure group (P <0.01 or 0.05). Except for the difference between the measured value of elastic resistance at 5 Hz and the predicted value (X5) and the peripheral resistance (Rp), there was a significant difference between the rest of indexes after respiratory failure in non-respiratory failure group and those in non-respiratory failure group (P <0 0 5). (2) Logistic regression analysis showed that there was a close correlation between respiratory rate (Fres)> 15Hz and viscosity at 20Hz> 150% and respiratory failure after pneumonectomy (P <0 01 or 0 0 5). R2 0> 140% was closely related to the occurrence of respiratory failure after lobectomy (P <0 05). (3) The sensitivity, specificity, and accuracy of Fres> 15Hz and R2 0> 150% predicting the occurrence of respiratory failure after pneumonectomy were close to or slightly higher than those of FEV1.060%. The sensitivity, specificity, and accuracy of R2 0> 140% predictive of respiratory failure after lobectomy were similar to those of MVV <50%. Conclusion Respiratory impedance can be used as an index to predict postoperative respiratory failure and evaluate the indications for surgery.