The Study Of The Exercise Cardie-pulmonary Function And Heart-lung Interaction In The Patients With Lung Cancer

Objective To observe the character of cardie-pulmonary function and heart-lung interaction during exercise in the patients with lung cancer, to explore the possible mechanism. Methods CPEX was measured in 20 healthy controls and 268 patients with primary lung cancer. Results 1. Comparing with the healthy group, VU%P , Vd/kg , AT, METS, d02/dW, to, HR, ft}/HR%, VTex, VE, VT/VC decreased(p<0. 05 or 0. 01) in the patients of normal pulmonary ventilation with lung cancer, BR increased(/KO. 05). 2. To explore the factors that influenced the cardio-pulmonary exercise function, we found that: (1) In the patients of normal pulmonary ventilation, only VE / VQ, of central group was higher than that of peripheral group (/KO. 05) ; (2)Comparing with the patients of stage I with lung cancer, only VT/VC decreased in the patients of stage II (/KO. 05), VQ,/HR% , VT/VC decreased and Vs/to, VE/VQ, increased (/KO. 05 or 0. 01) in the patients of stage IE, IV;(3)W%, VU%P, AT, VQ,/HR% of the group that great vessels invaded by tumor were lower than those of the group that great vessels were not invaded by tumor;(4)Comparing with the patients of normal pulmonary ventilation, W%, VQ,%P , VTex, BR, Sp02% decreased, BF, VE/ to, DY, VD/VT increased (p<0.05 or 0.01) in the groups of abnormal ventilation, especially the marked impairment group;(5)Comparing with the healthy group, W%, VU%P , VU/kg , AT, METS, to, RQ, HR, VQ/HR%, VTex, VE, VT/VC, Sp02% decreased, VE/to, DY, VD/VT increased 0*0. 05 or 0.01) in the patients of different type of pulmonary ventilation dysfunction, especially the group of mixed ventilation impairment ;(6)Comparing with the healthy group, VU%P , V^/kg , AT, METS, to, HR, Va/HR%, VTex, VE, SP02% decreased(/KO. 05 or 0.01), VD/VT increased(/KO. 05) in the patients of diffusing dysfunction, there was no relation with the degree of impairment; (7)Every index in the group of normal rest and exercising arterial oxygen pressure approached to that in the group of hypoxemia(p>0. 05);(8)Every index in the patients with positive exercise ECG and the patients with both the rest and exercise ECG were positive approached to that in the patients with normal rest and exercise ECG (/D>0. 05). 3. To explore the mechanism of heart-lung interaction in the patients with lung cancer, we found that:(l)There were no significant correlations between the indexes of rest pulmonary function and \Q/HR%;(2)During exercise VTex, VE, VT/VC correlated with VQ,/HR% generally. 4. To explore the clinical significance of cardio-pulmonary exercise test used in thoracic surgery, we concluded thatr(l) W%, VU%P, VQ/kg, METS, to, VQ/HR%, VTex, VE decreased few days after operation in the patients with lung cancer(/KO. 05 ^ 0.01); (2) Comparing with the group of single lobectomy, W%, VQ,%P decreased in the group of vessel shaping, HR increased in the group of pneumonectomy(y7<0. 01) ;(3)Comaring with the group of normal arterial blood gas, VC%> FEVj.0%, HW%, TLCOrb/VA, W%> VU%P, VU/kg, VU/HR%, BF decreased(/KO. 05 & 0.01) in the group of postoperative respiratory failure; (4)The sensitivity^ specificity^ correct ratio of diagnosis of VQ,%P<60%, VQ /kg<15ml/min/kg, VU/HR%<70%^ VT/VC<0. 40 were high for forecasting the postoperative respiratory failure. Conclusion There was decreasing tendency of exercise cardio-pulmonary function in the patients of lung cancer with normal pulmonary ventilation. There were close correlations between the further decrease of exercise cardio-pulmonary function and TNM stage> the degree of pulmonary ventilation impairement. Tumor invaded into great vessels^ ventilation impairement during rest and exercise were the main mechanism for abnormal cardiac function during exercise. CPEX could provide the basis for forecasting the postoperative respiratory failure.