Correlation Between Cardiopulmonary Function Test And Early Inflammatory Reaction After Pneumonectomy

Objective:The purpose of this study was to explore the relationship between preoperative cardiopulmonary exercise test（CPET）and the degree of early inflammatory response after lobectomy and its clinical significanceMethod:Retrospective analysis of 240 patients who underwent lobectomy in the thoracic surgery department of the First Affiliated Hospital of Dalian Medical University from September 2020 to may 2022.The clinical basic data of patients such as age,sex,BMI,location of pulmonary nodules,surgical procedure,pathological type,TNM stage and so on were recorded and statistically analyzed.The preoperative static pulmonary function data of patients were collected,including:forced vital capacity（FVC）,the percentage of FVC%PRED One second vital capacity（FEV₁）,one second vital capacity as a percentage of the predicted value FEV1%,one second rate（FEV₁/FVC）,and maximum ventilation as a percentage of the predicted value（MVV%）.Preoperative CPET data,including:kilogram oxygen uptake（VO₂/kg）,percentage of peak oxygen uptake to expected value（VO₂max）,maximum heart rate（HR）,metabolic equivalent（MET）,oxygen pulse（O₂pulse）,heart rate reserve（HRR）,respiratory rate（BF）,respiratory reserve（BR）,kilogram oxygen uptake at anaerobic threshold（VO₂/kg@AT）.percentage of oxygen uptake per kilogram in the expected value at anaerobic threshold(VO₂/kg@AT/kg%,oxygen ventilation equivalent（VE/VO₂@AT）Carbon dioxide ventilation equivalent（VE/VCO₂@AT）。At the same time,the blood routine data on the first day after operation were recorded,and the neutrophil lymphocyte ratio（NLR）,platelet lymphocyte ratio（PLR）,monocyte lymphocyte ratio（MLR）,albumin globulin ratio（AGR）were calculated.Patients were divided into normal ventilation group（n=190）and ventilation disorder group（n=50）according to preoperative static pulmonary function,and the differences of dynamic pulmonary function between the two groups were compared.The postoperative blood routine indicators NLR>10.65,PLR>221,MLR>0.72,AGR<1.33 were recorded as 1 point respectively,otherwise 0 point,and a scoring system（total score 0-4）was constructed.The patients were divided into early postoperative high inflammatory reaction group（2-4 points,n=137）and low inflammatory reaction group（0-1 points,n=103）.Independent sample t-test was used to compare the differences between the two groups in preoperative static lung function and CPET indicators,and univariate logistic regression was used to analyze the risk factors of early postoperative high inflammatory reaction,65 groups of patients were obtained after controlling the confounding factors between groups by propensity score matching（PSM）.Paired samples t-test was used for internal verification.Multivariate logistic regression was used to analyze the independent risk factors of early postoperative high inflammatory response,and multivariate ordered logistic regression was used to analyze the relationship between differential indicators and the degree of early postoperative inflammatory response.Result:1.There was no significant difference in clinical basic data such as age,sex,BMI,lung nodule location,surgical procedure,pathological type,TNM stage between the normal static pulmonary function ventilation group and the ventilation disorder group,the early postoperative high inflammatory reaction group and the low inflammatory reaction group（P>0.05）.2.The difference of VO₂max%and Br%between the normal group of static pulmonary function ventilation and the ventilation obstacle group was statistically significant（P<0.05）;There was no significant difference in static pulmonary function between the high inflammatory reaction group and the low inflammatory reaction group in the early postoperative period（P>0.05）.3.Preoperative VO₂/kg,VO₂max%,HR,MET%,O₂pulse%,BF,in the high inflammatory reaction group and low inflammatory reaction group in the early postoperative period VO₂/kg@AT、VO₂/kg@AT/kg%、VE/VO₂@AT The difference was statistically significant（P<0.05）;HRR,BR,VE/VCO₂@AT There was no significant correlation with the level of postoperative inflammatory response（P>0.05）.4.Single factor Logistic regression screened VO₂/kg,VO₂max%,HR,MET%,O₂pulse%,BF,before operation VO₂/kg@AT、VO₂/kg@AT/kg%、VE/VO₂@AT It was a risk factor for early postoperative high inflammatory response（P<0.05）.Multivariate logistic regression analysis showed that VO₂/kg,O₂ pulse and BF were independent risk factors for early postoperative high inflammatory response（P<0.05）.5.Multiple ordered logistic regression analysis showed that VO₂/kg and BF were significantly correlated with the degree of early postoperative inflammatory reaction（P<0.05）.Conclusion:Preoperative CPET examination is of high value in predicting the degree of early postoperative inflammatory reaction.For patients with poor VO₂/kg and BF in preoperative CPET results,early intervention measures can be taken to effectively control the degree of early postoperative systemic inflammatory reaction disorder.