Objective: To investigate the value of lung function for the prognosis of cardiac surgery in patients with chronic obstructive pulmonary disease(COPD). Methods: A retrospective analysis was conducted on the hospitalized patients with coronary heart disease or valvular heart disease in Beijing Anzhen hospital during Janury 2013 to December 2015. The relationship between lung function and extubation time, time of staying in ICU, second time tracheal incubation, tracheotomy and mortality rate were analyzed. Results: There were 355 patients without surgery in a total 1 729 of patients, of which 65 (18.31%)suffered from severe pulmonary dysfunction. There were 242 patients with obstructive ventilation dysfunction, 75 with mild, 127 with moderate, and 40 with severe and very severe obstructive ventilation dysfunction. There were significant differences in the rates of planned extubation and late extubation between patients with normal lung function (81.6% and 10.7%) and those with abnormal lung function(74.4% and 12.8%). In patients with different GOLD classification (Ⅰ, Ⅱ, and Ⅲ-Ⅳ), there were significant differences in the rates of early extubation 14.7%, 14.2% and 5%, planned extubation (80%, 74% and 65%) and late extubation (5.3%, 11.8% and 30%). By comparison with patients without COPD, the extubation time of COPD patients increased by 20.3%, the time of staying in ICU prolonged by 14.2%, and the mortality rate increased to 180%(P<0.05). However, there was no significant difference in the rate of second time tracheal incubation or tracheotomy. Conclusion: There was a close relationship between GOLD classification and prognosis of cardiac surgery patients with COPD. Cardiac surgery needs to be cautious because of increase in incidence of postoperative adverse events in patients with severe pulmonary dysfunction.
目的：研究肺功能对合并慢性阻塞性肺疾病(慢阻肺)患者心脏外科手术预后的影响。 方法：回顾性分析2013年1月至2015年12月在北京安贞医院心脏外科住院的冠心病、心脏瓣膜病及先天性心脏病患者1 729例，355例患者未手术，主要原因为严重肺功能减退(65/355，18.3%)；1 374例手术患者中男764例，女610例，平均年龄(57±11)岁。根据肺功能检查结果将手术患者分为肺功能正常组(1 132例)和肺功能异常组(242例)，根据慢阻肺全球创议(GOLD)指南将肺功能异常患者分为GOLD 1级75例，GOLD 2级127例，GOLD 3～4级40例。比较患者术前肺功能分级与术后拔管时间、住ICU时间、二次插管或气管切开及病死率之间的关系。 结果：肺功能正常组常规拔管和延迟拔管的比例分别为81.6%和10.7%，肺功能异常组常规拔管和延迟拔管的比例分别74.4%和12.8%(P<0.05)。肺功能异常组中不同GOLD分级患者早期拔管率分别为GOLD 1级14.7%，GOLD 2级14.2%，GOLD 3～4级5%；常规拔管率分别为：GOLD 1级80%，GOLD 2级74%，GOLD 3～4级65%；延迟拔管率分别为：GOLD 1级5.3%，GOLD 2级11.8%，GOLD 3～4级30%(P<0.05)；与肺功能正常组相比，慢阻肺患者拔管时间延长20.3%，ICU停留时间延长14.2%，术后病死率增加180%(P<0.05)，两组间二次插管或气管切开比例差异无统计学意义。 结论：术前肺功能分级与合并慢阻肺患者的心脏外科术后恢复及不良事件发生率密切相关，对于严重肺功能障碍者，术后不良事件发生率明显增加，手术需谨慎。.
Keywords: Cardiac surgery; Lung function; Pulmonary disease, chronic obstructive.