Prevalence And Rate Of Missed Diagnosis Study In Presurgical Patients And Prognostic Value Of Presurgical Pulmonary Function Test In The Heart Surgery

Part 1Prevalence and rate of missed diagnosis study in presurgical patientsObjective To invest the prevalence and the missed diagnosis rate in presurgical patients and their relation with high risk factors.Methods Carrying out epidemic study in presurgical patients who received pulmonary function test in PFT laboratory of Zhongshan hospital between Nov,2007-Dec,2007.339 patients were selected and their general conditions,exposure history and PFT results were analyzed. Results The prevalence of COPD was 21.8%,and the missed diagnosis rate was 83.8%.53.1%subjects had positive exposure history,among which 43.1%had smoking history and 18.6%had occupational exposure history,with the prevalence 30.4%and 36.5%,between which no statistical significance revealed.The prevalence of COPD in subjects with negative exposure history was 8.8%,and the missed diagnosis rate was 71.4%.The prevalence of COPD with and without exposure history above the age of 50 was 38.0%and 10.0%,the former was significantly higher(P＜0.001).The prevalence of COPD of men was 25.1%,which was significantly higher than that of women 15.2%(P=0.04),logistic regression analysis showed that the prevalence had little relation with gender(OR=0.80,95%CI: 0.42-1.51),and had relation with exposure history(OR=4.22,95%CI: 2.35-8.34).The severity classification of 62 COPD patients who were newly diagnosed after this PFT:stageⅠ30.65%,stageⅡ:56.45%,stageⅢ:11.29%, stageⅣ:1.6%.Conclusion Most of presurgical patients have the risk factors of COPD like smoking and occupational exposure,and the latter is especially higher in our country.The prevalence and the rate of missed diagnosis of COPD is very high and the classification of severity of most missed diagnosed patients is stageⅡor even more server. Part 2Sutdy of pulmonary ventilaory dysfunction and relative factors in patients before cardiac surgeryObjective To invest the prevalence of pulmanory ventilatory dysfunction and relative factors before cardiac surgery.Methods Carrying out retrospective study in cardio-presurgical patients who received pulmonary function test in PFT laboratory of Zhongshan hospital between July,2007-July,2008.205 patients were selected,and their general conditions,history of smoking,heart disease and PFT results were analyzed.Results The morbidity rate of pulmonary ventilatory dysfuncion was 62.4%,with 33.7%in restrictive type,17.6%in obstructive type,11.2%in mixed type.20.5%of the patients had reached the moderate or severe stage.The value of FEV1 was 0.45-3.54(1.98±0.59) L,with 16.6%(34 cases) in 1.0L＜FEV1≤1.5L and 4.4%(9 cases) in FEV1≤1.OL.The morbidity rate of pulnomary ventilatory dysfuncion in 66 cases of heavy smokers was 69.7%,and 16.7%of them had reached the moderate or severe stage,which was no significant difference with that of nonsmokers(P＞0.05 )。In 142 patients(69.3%) who had more than 6 months of heart disease,The morbidity rate of pulnomary ventilatory dysfuncion in 142 cases patients(69.3%) who had heart disease for more than 6 months was 69.0%,and 24.6%of them had reached the moderate or severe stage,which was higher than that with heart disease for 6 months or less (P＜0.05).Conclusion In cardio-presurgical patients,the morbidity rate of pulnomary ventilatory dysfuncion is high,and with high ratio of reaching moderate or severe stage.In the patients who had more than 6 months of heart disease,the pulnomary ventilatory dysfuncion is even more severe. July,2007-July,2008.205 patients were selected,and was divided into 4 groups: patients with normal pulmonary function,patients with mild pulmonary dysfunction, patients with moderate pulmonary dysfunction,patients with severe pulmonary dysfunction,and analysised the relationship between the stage of pulmanory function and the mal-prognosis:choosing not to be operated,death in the hospital,the time of using artifical airway≥3 days or the ICU stay≥5 days.Univariate and multivariate logistic analysis were used to identify the risk factors.Results 197 cases were selected,43.7%patients with FEV1%pred≥80%,36.5% with 60%≤FEV1%pred＜80%,15.7%with 40%≤FEV1%pred＜60%and 4.1%with FEV1:＜40%.47.4%of the reason why the patients had been prepared to be operated but given up is because of severe pulmonary dysfunction.The occurance rates of giving up were 0%in the normal pulmonary function,1.4%in mild dysfunction,12.9% in moderate dysfunction,50%in severe dysfunction,which was rising with the decline of pulmanary function(P＜0.001).The mortality were 1.3%in the normal pulmonary function,1.5%in mild dysfunction,7.4%in moderate dysfunction,0%in severe dysfunction,which had not statistical significance(P=0.28).The occurance rates of use of artifical airway≥3 days or ICU stay≥5 days were 4.5%in mild dysfunction,8.0%in moderate dysfunction,25.0%in severe dysfunction,which was rising with the decline of pulmanary function,but had not statistical significance (P=0.26).The occurance rates of use of artifical airway≥3days or ICU stay≥3 days were 12.7%in the normal pulmonary function.Univariate risk factors showed that the valula disease and the use of CPB was realated with the occurance rates of use of artifical airway≥3 days or ICU stay≥5 days(P＜0.001).Conclusion Patients with moderate to severe pulmanary dysfunction are easy to choose to refuse the choice of operation.There are many prognostic factors in cardiac surgery,which may reduce the prognostic impact of the pulmonary dysfunction,but more cases need to be collected to analyse.