目的：探讨内蒙古医科大学附属医院肝胆外科手术患者术前肺功能指标对患者术后并发症的预测能力，提高手术安全性。 方法：对48例我院肝胆外科手术患者签署知情同意书后行手术前常规肺功能及运动心肺功能检查，在术后3个月后行常规肺功能和运动心肺功能复查，并追踪术后1个月内有无发生术后心肺并发症（PPC）等情况。 结果：1.在行手术的患者中，术后发生PPC组和无发生PPC组的术前静息肺功能肺功能FEV1/pred 、 DLCO/pred等指标差异无显著性意义（P＞0.05）。2.有PPC组与无PPC组，术前运动心肺功能比较结果示VO2max/pred，VO2max/kg/pred，AT，O2HR/pred等指标的差异均有显著性意义（P＜0.05）。3. 术后发生PPC组和无PPC组的术前运动心肺功能试验中VO2max/pred＜60%，VO2max/kg＜15/min?kg，O2HR/pred＜70%时术后PCC发生率有显性著差异。（P＜0.05），在AT＞11ml/min/kg组发生PPC较AT＜11ml/min?kg组比较差异有显著性意义（P＜0.05）。 结论：1.运动心肺功能试验在预测肝胆手术术后并发症的有重要意义，优于静息肺功能。2.在预测肝胆手术后并发症时可参考的指标为：如VO2max%＜60%时需，综合评估患者情况，谨慎考虑手术。VO2max/kg＜15ml/min?kg时术后发生PPC可能性较大，因谨慎考虑手术。O2/HRmax%pred＜70%时，需谨慎考虑手术，AT＜11ml/min?kg需谨慎考虑手术，危险性较大，而AT＞11ml/min?kg危险性较少。

Objective: To investigate the evolution of exercise cardiopulmonary function before and after surgery in patients undergoing hepatobiliary surgery, explore the predictive ability of preoperative pulmonary function indexes for postoperative complications, and improve Surgical safety.Methods: 48 patients with hepatobiliary surgery signed informed consent before surgery after routine lung function and exercise cardiopulmonary function tests, after 3 months of routine pulmonary function and exercise cardiopulmonary function review and follow-up within 1 month No postoperative cardiopulmonary complications (PPC) and so on. RESULTS: 1. In patients who underwent surgery, postoperative PPC and no PPC preoperative resting pulmonary function lung function FEV1/pred, FVC/pred, MVV/pred, FEV1/FVC/pred, DLCO/ There was no significant difference in pred and other indicators (P>0.05). There were significant differences between the PPC group and the no PPC group (P<0.05). The preoperative cardiac and pulmonary function comparison showed that the VO2max/pred, VO2max/kg/pred, AT, O2HR/pred and other indicators were significantly different (P<0.05). 3. Postoperative PCC and PPC-free preoperative exercise cardiopulmonary function test showed significant postoperative PCC incidence with VO2max/pred < 60%, VO2max/kg <15/min ? kg, and O2HR/pred < 70%.PPC in AT>11 ml/min/kg group had significant difference compared with AT<11 ml/min?kg group (P<0.05). Conclusions: 1. Exercise cardiopulmonary function test is of great significance in predicting the postoperative complications of hepatobiliary surgery. It is superior to resting lung function. 2. In the prediction of complications after hepatobiliary surgery can be referenced as indicators: If VO2max% < 60%, comprehensive assessment of patient conditions, careful consideration of surgery. PPC is more likely to occur after VO2max/kg<15ml/min ? kg, due to careful consideration of surgery. When O2/HRmax%pred<70%, surgery should be carefully considered. AT<11ml/min?kg should be carefully considered for surgery, and the risk is greater, while AT>11ml/min?kg is less risky.

R320.99

内蒙古教育厅高等学校科学研究重点项目NJZZ19091