摘要
目的分析肿瘤致恶性中心气道狭窄(MCAO)患者气道支架置入术后近期疗效及远期存活时间的影响因素。方法选择2017年1月至2019年6月在本院接受气道支架置入术治疗的120例肿瘤致MCAO患者,根据狭窄原因分为外压性狭窄组72例和非外压性狭窄组48例。记录患者肿瘤类型、肿瘤分期、分化程度、气道狭窄位置、狭窄程度、术前乳酸脱氢酶水平等一般资料。分别在支架置入前和置入后第7 d,检测动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和动脉血氧饱和度(SaO_(2))。在支架置入前和支架置入后1个月,检测气道狭窄段直径、气道狭窄程度和第1秒用力呼气容积(FEV1),评估患者气促指数和卡氏评分(KPS)评分。随访患者术后1年的生存情况,采用Kaplan-Meier分析患者术后1年的生存时间,COX风险比例回归分析影响支架置入术后生存时间的危险因素。结果外压性狭窄组和非外压性狭窄组MCAO患者支架置入后的PaO_(2)、SaO_(2)、气道狭窄段直径、FEV1和KPS评分明显高于支架置入前(P<0.05),PaCO_(2)、气道狭窄程度和气促指数明显低于支架置入前(P<0.05);外压性狭窄组支架置入后KPS评分明显高于非外压性狭窄组,气促指数明显低于非外压性狭窄组(P<0.05);外压性狭窄组患者的生存率为29.17%,中位生存时间为7.35个月;非外压性狭窄组的生存率为22.92%,中位生存时间为6.10个月,两组间差异无统计学意义(Log-rankχ^(2)=1.542,P=0.214);COX比例风险回归分析显示,肿瘤分期为Ⅳ期(OR=2.056,P=0.020)、术前KPS评分<50分(OR=2.002,P=0.027)和无术后放化疗(OR=4.292,P=0.039)为影响MCAO患者支架置入术后1年生存时间的独立危险因素。结论气道支架置入术治疗肿瘤致MCAO患者具有良好的临床疗效,肿瘤分期为Ⅳ期、术前KPS评分<50分和无术后放化疗均为影响患者术后生存时间的危险因素。
Objective To analyze the influencing factors of short-term curative effect and long-term survival time of patients with tumor-induced malignant central airway obstruction(MCAO)after airway stent implantation.Methods A total of 120 patients with tumor-induced MCAO who underwent airway stent implantation in the hospital from January 2017 to June 2019 were enrolled.According to the cause of stenosis,the patients were divided into two groups:external pressure stenosis group(n=72)and non-external pressure stenosis group(n=48).The general data such as types and staging of tumor,differentiation degree,sites of airway obstruction,obstruction degree and preoperative level of lactate dehydrogenase(LDH).Before and at 7 d after stent implantation,partial pressure of oxygen(PaO_(2)),partial pressure of arterial carbon dioxide(PaCO_(2))and saturation of arterial blood oxygen(SaO_(2))were detected.Before and at 1 month after stent implantation,diameter at airway obstruction segment,degree of airway obstruction and forced expiratory volume in the first second(FEV1)were detected.Dyspnea index(DI)and scores of Karnofsky performance status(KPS)were evaluated.The survival status at 1 year after surgery was followed up.The survival at 1 year after surgery was analyzed by Kaplan-Meier.The influencing factors of survival after stent implantation were analyzed by COX proportional hazard regression analysis.Results After stent implantation,PaO_(2),SaO_(2),diameter at airway obstruction segment,FEV1 and KPS score were significantly increased(P<0.05),while PaCO_(2),degree of airway obstruction and DI were significantly decreased in external pressure stenosis group and non-external pressure stenosis group(P<0.05).After stent implantation,the KPS score was significantly higher in external pressure stenosis group than that in non-external pressure stenosis group,and the shortness of breath index was significantly lower than that in non-external pressure stenosis group(P<0.05).The survival rate of patients with external pressure stenosis group
作者
唐飞
吕莉萍
范晓云
TANG Fei;LV Liping;FAN Xiaoyun(Department of Geriatric Respiratory and Critical Care Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230011,P.R.China;Department of Endoscopy and Interventional Pulmonary Diseases,Anhui Chest Hospital,Hefei,Anhui 233003,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2021年第9期643-648,共6页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
恶性中心气道狭窄
支架置入术
气道狭窄
生存时间
Malignant central airway obstruction
Stent implantation
Airway obstruction
Survival time
