本文選題：肺癌 + 全肺切除�。� 參考：《天津醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:目前,肺癌臨床手術(shù)切除后,心肺并發(fā)癥(postoperative cardiopulmonary complication,PCC)的發(fā)病率較高,這些并發(fā)癥,重者危及患者的生命,輕者也會(huì)影響患者的生存質(zhì)量。為此,對(duì)于肺癌術(shù)后并發(fā)癥的預(yù)防在臨床肺癌手術(shù)治療中具有重要的意義。如果能通過(guò)對(duì)肺癌患者術(shù)前肺通氣功能和脈沖振蕩(IOS)檢測(cè),評(píng)估、預(yù)測(cè)術(shù)后并發(fā)癥的發(fā)生,則可通過(guò)調(diào)整手術(shù)方案和術(shù)中、術(shù)后用藥,加強(qiáng)圍手術(shù)期的護(hù)理,達(dá)到降低術(shù)后心肺并發(fā)癥發(fā)生的目的。因此本研究分析了術(shù)前肺功能各指標(biāo)與術(shù)后并發(fā)癥發(fā)生的相關(guān)性,擬通過(guò)肺癌患者術(shù)前肺通氣功能和脈沖振蕩(IOS)檢測(cè)指標(biāo),評(píng)估、預(yù)測(cè)術(shù)后并發(fā)癥的發(fā)生風(fēng)險(xiǎn)。方法:(1)收集2008年1月至2010年12月200例施行左全肺切除手術(shù)的肺癌患者臨床資料,根據(jù)患者術(shù)后1月內(nèi)有無(wú)發(fā)生心肺并發(fā)癥分為PCC組和無(wú)PCC組,分析術(shù)前正常、輕度、中度及重度肺功能減低對(duì)術(shù)后并發(fā)癥發(fā)生的影響。(2)收集2012年1月至2012年12月行左全肺切除術(shù)的肺癌患者臨床資料100例,其中術(shù)后出現(xiàn)呼吸衰竭并發(fā)癥50例,未出現(xiàn)并發(fā)癥50例。比較出現(xiàn)呼衰和無(wú)呼衰患者術(shù)前IOS檢測(cè)各項(xiàng)指標(biāo)的差異性;比較中心型肺癌與周圍型肺癌術(shù)前IOS檢測(cè)各項(xiàng)指標(biāo)的差異性。(3)對(duì)200例肺癌患者的FEV1%、MVV%參數(shù)按3:1比例和50例肺癌患者IOS各參數(shù)按4:1比例,應(yīng)用BP神經(jīng)網(wǎng)絡(luò)方法對(duì)術(shù)后并發(fā)癥的發(fā)生進(jìn)行了預(yù)測(cè)。結(jié)果:(1)200例患者中正常、輕度、中度及重度肺功能減低各35、45、98、22例,術(shù)后1月內(nèi)PCC發(fā)生率分別為28.6%、53.3%、60.2%、77.3%,與正常組相比,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步分析顯示:當(dāng)FEV1%或MVV%單獨(dú)輕度減低時(shí),患者術(shù)后PCC的發(fā)生率分別為40%、35.29%,與正常組相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);而當(dāng)FEV1%和MVV%同時(shí)輕度減低時(shí),PCC的發(fā)生率為78.57%,差異具有顯著性(P0.01)。當(dāng)FEV1%或MVV%單獨(dú)、同時(shí)中度減低時(shí),患者術(shù)后PCC的發(fā)生率分別為52.63%、55.55%、69.04%,,與正常相比,差異有統(tǒng)計(jì)學(xué)意義(P≤0.05);當(dāng)FEV1%或MVV%單獨(dú)重度度減低時(shí),由于樣本量過(guò)小,無(wú)法進(jìn)行統(tǒng)計(jì)學(xué)分析;而當(dāng)FEV1%和MVV%同時(shí)重度減低時(shí),PCC的發(fā)生率為89.47%,與正常相比,差異性非常顯著(P0.01)。(2)呼衰組與非呼衰組術(shù)前IOS各項(xiàng)檢測(cè)指標(biāo)均有顯著性差異(P0.05);中央型肺癌組與周圍型肺癌組比較,除R20無(wú)顯著性差異外,其它指標(biāo)具有顯著性差異。(3)200例患者FEV1%、MVV%建立的模型中,擬合率為94.37%,預(yù)測(cè)精度達(dá)90%以上,平均誤差為0.023;50例患者IOS各參數(shù)建立的模型中,擬合率為99.73%,預(yù)測(cè)精度達(dá)90%以上,平均誤差為0.020。結(jié)論:(1)術(shù)前肺功能狀態(tài)直接影響術(shù)后并發(fā)癥的發(fā)生,肺功能下降是術(shù)后并發(fā)癥發(fā)生的危險(xiǎn)因素。隨著肺功能的進(jìn)一步下降,其并發(fā)癥發(fā)生率呈上升趨勢(shì),各下降組與正常組相比P0.05,且差異的顯著性增加。FEV1%、MVV%其中一項(xiàng)單獨(dú)輕度減低與正常組相比,對(duì)并發(fā)癥的發(fā)生無(wú)顯著影響,當(dāng)FEV1%及MVV%同時(shí)輕度減低是肺癌左全切術(shù)后PCC發(fā)生的危險(xiǎn)因素,應(yīng)加強(qiáng)圍手術(shù)期管理,降低PCC的發(fā)生。FEV1%、MVV%其中一項(xiàng)中度減低,都會(huì)影響術(shù)后并發(fā)癥的發(fā)生,若兩者同時(shí)中、重度減低,則術(shù)后發(fā)生并發(fā)癥的可能性更大。因此術(shù)前肺通氣功能檢測(cè)指標(biāo)FEV1%、MVV%的降低是影響肺癌左全肺切除術(shù)后并發(fā)癥發(fā)生的危險(xiǎn)因素,且降低程度越大,并發(fā)癥發(fā)生的風(fēng)險(xiǎn)越高。(2)肺癌術(shù)前呼吸阻抗IOS檢測(cè)指標(biāo)有助于評(píng)估左全肺切除術(shù)后呼吸衰竭并發(fā)癥的發(fā)生風(fēng)險(xiǎn)性,對(duì)手術(shù)適應(yīng)證的評(píng)估起到重要作用。(3)在本研究中,肺通氣功能參數(shù)與脈沖振蕩肺功能參數(shù)建立的BP神經(jīng)網(wǎng)絡(luò)預(yù)測(cè)術(shù)后并發(fā)癥的發(fā)生是可行的,但因樣本量有限,其應(yīng)用有待進(jìn)一步研究。
[Abstract]:Objective: at present, the incidence of postoperative cardiopulmonary complication (PCC) is higher after surgical resection of lung cancer. These complications will endanger the life of the patients, and the light will also affect the quality of life of the patients. Therefore, the prevention of postoperative complications of lung cancer is of great importance in the clinical treatment of lung cancer. If the preoperative pulmonary ventilation function and pulse oscillation (IOS) can be detected, the postoperative complications can be predicted and the postoperative complications can be predicted, and the perioperative care can be improved by adjusting the operation plan and intraoperative and postoperative medication to reduce the incidence of postoperative cardiopulmonary complications. The correlation between postoperative complications and postoperative pulmonary ventilation function and pulse oscillation (IOS) was used to assess and predict the risk of postoperative complications. Methods: (1) 200 cases of lung cancer patients with left total pneumonectomy from January 2008 to December 2010 were collected. The pulmonary complications were divided into PCC group and no PCC group. The effect of normal, mild, moderate and severe pulmonary dysfunction on postoperative complications was analyzed. (2) 100 cases of lung cancer patients were collected from January 2012 to December 2012, including 50 cases of postoperative complications of respiratory failure and 50 cases without complications. The difference between the preoperative IOS detection indexes of patients with respiratory failure and non respiratory failure, and the difference between the indexes of IOS detection before operation for central lung cancer and peripheral lung cancer. (3) for the FEV1% of 200 cases of lung cancer, the MVV% parameters were proportional to the 3:1 ratio and the IOS parameters of 50 cases of lung cancer, and the BP neural network method was applied to the postoperative complications. Results: (1) in 200 patients with normal, mild, moderate and severe pulmonary dysfunction, the incidence of PCC in January was 28.6%, 53.3%, 60.2%, 77.3%, respectively. The difference was statistically significant (P0.05) compared with the normal group (P0.05). Further analysis showed that when FEV1% or MVV% was slightly reduced, the occurrence of PCC in patients after operation was observed. The rates were 40% and 35.29% respectively, compared with the normal group, the difference was not statistically significant (P0.05), while the incidence of PCC was 78.57% when FEV1% and MVV% decreased at the same time, and the difference was significant (P0.01). When FEV1% or MVV% alone, and moderate reduction, the incidence of postoperative PCC was 52.63%, 55.55%, 69.04%, respectively. The study significance (P < 0.05); when the FEV1% or MVV% individual severity decreased, there was no statistical analysis due to the small sample size, while the incidence of PCC was 89.47% when FEV1% and MVV% were severely reduced (P0.01). (2) there were significant differences between the pre operation IOS of the paging and non respiratory failure groups (2) P0.05): compared with the peripheral lung cancer group, the central lung cancer group and the peripheral lung cancer group had no significant difference. (3) in the 200 patients with FEV1% and MVV%, the fitting rate was 94.37%, the prediction accuracy was more than 90% and the average error was 0.023. The fitting rate of the IOS parameters in the 50 patients was 99.73%, and the prediction accuracy was 99.73%. Up to 90%, the average error was 0.020. conclusion: (1) the preoperative pulmonary functional status directly affected the postoperative complications, and the decrease of lung function was the risk factor for postoperative complications. With the further decline of the lung function, the incidence of complications increased, and the decrease group was compared with the normal group P0.05, and the difference was significantly increased by.FEV1%, M A single mild reduction in VV% has no significant effect on the occurrence of complications compared with the normal group. When FEV1% and MVV% are reduced at the same time as a risk factor for PCC after left total left lung resection of lung cancer, perioperative management should be strengthened to reduce the incidence of.FEV1% in PCC, and a moderate reduction in MVV% will affect the occurrence of postoperative complications, if both of them may affect the incidence of postoperative complications. At the same time, severe reduction, the possibility of postoperative complications is more likely. Therefore, preoperative pulmonary ventilation function detection index FEV1%, MVV% decrease is the risk factor for the complications after lung cancer left total pneumonectomy, and the greater the degree of reduction, the higher the risk of complications. (2) preoperative respiratory impedance IOS detection index of lung cancer is helpful for evaluation. It is important to estimate the risk of complications of respiratory failure after left total pneumonectomy and play an important role in the evaluation of surgical indications. (3) in this study, the BP neural network of pulmonary ventilation function parameters and pulse oscillatory pulmonary function parameters is feasible to predict the occurrence of postoperative complications, but its application remains to be further studied because of the limited sample size.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R734.2

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