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中华肺部疾病杂志(电子版) ›› 2025, Vol. 18 ›› Issue (06) : 923 -928. doi: 10.3877/cma.j.issn.1674-6902.2025.06.012

论著

VE/VCO2斜率对非小细胞肺癌视频辅助胸腔镜术后持续性漏气的预测意义
王晓强1, 孙玉满2,†(), 郑玄1, 赵鑫鑫1, 郑晶晶1   
  1. 1063000　唐山，唐山职业技术学院附属医院胸外科
    2063000　唐山，唐山职业技术学院附属医院病理科
  • 收稿日期:2025-07-22 出版日期:2025-12-25
  • 通信作者: 孙玉满
  • 基金资助:
    河北省卫生健康委课题项目(20181313)

Prediction significance of VE/VCO2 slope for persistent air leakage after video-assisted thoracoscopic surgery in non-small cell lung cancer

Xiaoqiang Wang1, Yuman Sun2,†(), Xuan Zheng1, Xinxin Zhao1, Jingjing Zheng1   

  1. 1Department of Cerebral Surgery, Tangshan Vocational and Technical College Affiliated Hospital, Tangshan, Hebei 063000, China
    2Department of Pathology, Tangshan Vocational and Technical College Affiliated Hospital, Tangshan, Hebei 063000, China
  • Received:2025-07-22 Published:2025-12-25
  • Corresponding author: Yuman Sun
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引用本文：

王晓强, 孙玉满, 郑玄, 赵鑫鑫, 郑晶晶. VE/VCO2斜率对非小细胞肺癌视频辅助胸腔镜术后持续性漏气的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 923-928.

Xiaoqiang Wang, Yuman Sun, Xuan Zheng, Xinxin Zhao, Jingjing Zheng. Prediction significance of VE/VCO2 slope for persistent air leakage after video-assisted thoracoscopic surgery in non-small cell lung cancer[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 923-928.

目的

探讨通气效率[每分钟通气量(minute ventilation, VE)/二氧化碳排出量(carbon dioxide output, VCO2)斜率]对非小细胞肺癌(non-small cell lung cancer, NSCLC)患者视频辅助胸腔镜术(video-assisted thoracoscopic surgery, VATS)后持续性肺漏气(prolonged air leak, PAL)的预测意义。

方法

回顾性选择2022年3月至2024年8月我院收治的接受视频辅助胸腔镜解剖肺切除术NSCLC患者82例。根据术后是否发生PAL分组，发生PAL 15例为观察组，未发生PAL 67例为对照组。术前进行肺功能、心肺运动试验(cardiopulmonary exercise testing, CPET)，记录VE/VCO2斜率。

结果

观察组VE/VCO2斜率32.00(28.00，35.00)高于对照组27.00(24.00，31.00)(P<0.05)。VE/VCO2斜率预测PAL的受试者工作特征(receiver operating characteristic, ROC)曲线下面积(area under curve, AUC)为0.833(95%CI：0.731~0.936)，截断值为31.5，敏感度为80.00%，特异度为79.10%。Logistic回归分析显示，吸烟史[OR(95%CI)：8.006(1.013~63.279)]、1秒用力呼气容积占预计值百分比(percentage of forced expiratory volume in one second in predicted value, FEV1%)[OR(95%CI)：0.088(0.009~0.864)]、胸膜黏连[OR(95%CI)：10.366(1.225~87.752)]、VE/VCO2斜率[OR(95%CI)：28.889(3.851~216.729)]是PAL的危险因素(P<0.05)。ROC曲线分析显示列线图模型预测术后PAL风险的AUC为0.914(95%CI：0.851~0.977)，敏感度和特异度分别为93.30%和74.60%。经Hosmer-Lemeshow拟合优度检验拟合良好(χ2＝0.992，P＝0.986)。临床决策曲线分析，高风险阈值为0.03~0.82时预测术后PAL净临床收益好。

结论

VE/VCO2斜率与NSCLC患者VATS术后PAL风险增加有关，VE/VCO2斜率越大，通气效率越低，术后发生PAL风险越高。

关键词: 非小细胞肺癌, 视频辅助胸腔镜手术, 通气效率, 持续性肺漏气
Objective

To investigate the predictive significance of ventilatory efficiency [the slope of minute ventilation (VE) to carbon dioxide output (VCO2)] for prolonged air leak (PAL) after video-assisted thoracoscopic surgery (VATS) in patients with non-small cell lung cancer (NSCLC).

Methods

A retrospective selection was made of 82 NSCLC patients who underwent video-assisted thoracoscopic anatomic lung resection in our hospital from March 2022 to August 2024. Based on the occurrence of postoperative PAL, patients were divided into two groups: 15 patients with PAL constituted the observation group, and 67 patients without PAL constituted the control group. Preoperative pulmonary function tests and cardiopulmonary exercise testing (CPET) were performed, and the VE/VCO2 slope was recorded.

Results

The VE/VCO2 slope in the observation group was 32.00 (28.00, 35.00), which was higher than that in the control group [27.00 (24.00, 31.00)](P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the VE/VCO2 slope predicting PAL was 0.833 (95%CI: 0.731~0.936), with a cutoff value of 31.5, a sensitivity of 80.00%, and a specificity of 79.10%. Logistic regression analysis showed that smoking history [OR(95%CI): 8.006 (1.013~63.279)], percentage of forced expiratory volume in one second in predicted value (FEV1%) [OR(95%CI): 0.088 (0.009~0.864)], pleural adhesion [OR(95%CI): 10.366 (1.225~87.752)], and VE/VCO2 slope [OR(95%CI): 28.889(3.851~216.729)] were risk factors for PAL(P<0.05). ROC curve analysis showed that the nomogram model for predicting the risk of postoperative PAL had an AUC of 0.914 (95%CI: 0.851~0.977), with a sensitivity and specificity of 93.30% and 74.60%, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated a good fit (χ2=0.992, P=0.986). Clinical decision curve analysis showed a good net clinical benefit for predicting postoperative PAL when the high-risk threshold was between 0.03 and 0.82.

Conclusion

Ventilatory efficiency (VE/VCO2 slope) is associated with an increased risk of PAL after VATS in NSCLC patients. A higher VE/VCO2 slope indicates lower ventilatory efficiency and a higher risk of postoperative PAL.

Key words: Non-small cell lung cancer, Video-assisted thoracoscopic surgery, Ventilation efficiency, Prolonged air leak
表1 两组NSCLC患者临床资料结果比较
临床资料 观察组(n＝15) 对照组(n＝67) t/χ2/Z值 P值
吸烟史[n(%)] 5(33.33) 8(11.94) 4.205 0.040
合并症[n(%)]        
高血压 4(26.67) 24(35.82) 0.457 0.499
糖尿病 4(26.67) 10(14.93) 1.193 0.275
冠心病 2(13.33) 7(10.45) 0.104 0.747
病理亚型[n(%)]     1.212 0.546
肺腺癌 6(40.0) 34(50.75)    
肺鳞癌 6(40.0) 26(38.81)    
其他 3(20.0) 7(10.45)    
TNM分期[n(%)]     0.025 0.875
ⅠB-Ⅱ期 13(86.67) 57(85.07)    
ⅢA-ⅢB期 2(13.33) 10(14.93)    
ASA评分[n(%)]     2.267 0.132
Ⅰ级 8(53.33) 49(73.13)    
Ⅱ级 7(46.67) 18(26.87)    
手术类型[n(%)]     1.140 0.565
楔形切除术 3(20.0) 16(23.88)    
肺叶切除术 12(80.0) 47(70.15)    
肺节段切除术 0(0.0) 4(5.97)    
VATS手术方式[n(%)]     2.549 0.110
单孔法 13(86.67) 44(65.67)    
双孔/三孔法 2(13.33) 23(34.33)    
根治性(R0)切除[n(%)] 14(93.33) 61(91.04) 0.082 0.774
肺功能(±s)        
FEV1%(%) 86.13±17.29 98.14±17.55 2.402 0.019
FVC%(%) 96.47±12.36 103.36±16.19 1.547 0.126
FEV1/FVC 0.74±0.12 0.75±0.08 0.396 0.693
DLCO%(%) 98.40±27.63 96.31±20.50 0.334 0.739
表2 两组NSCLC患者CPET参数结果[(±s)，M(Q25，Q75)]
CPET指标 观察组(n＝15) 对照组(n＝67) t/Z值 P值
静息时        
PaO2(kPa) 10.20±0.76 10.68±1.27 1.404 0.164
PaCO2(kPa) 4.58±0.45 4.62±0.45 0.311 0.757
pH 7.44±0.02 7.45±0.03 1.228 0.223
VO2(ml/kg－1·min－1) 4.00(3.30，4.60) 4.50(3.60，5.10) －0.336 0.737
VCO2(L/min) 0.28(0.24，0.37) 0.28(0.21，0.40) －0.901 0.368
RER 0.87(0.81，0.90) 0.82(0.78，0.89) －0.636 0.525
VO2/HR(ml/beat) 4.10(3.10，5.20) 4.40(3.40，6.10) －0.450 0.653
VE(L/min) 13.00±4.79 11.70±3.36 1.247 0.216
VT(L) 0.69±0.24 0.66±0.19 0.526 0.600
Fb(bpm) 18.80±2.96 18.45±4.06 0.315 0.754
VD/VT 0.31±0.06 0.34±0.07 1.536 0.128
ETCO2(mmHg) 29.00(25.00，31.00) 31.00(29.00，33.00) －1.449 0.147
峰值运动时        
PaO2(kPa) 11.26±1.78 12.07±1.95 1.476 0.144
PaCO2(kPa) 4.68±0.69 4.66±0.51 0.128 0.898
pH 7.34±0.04 7.35±0.04 0.875 0.384
VO2(ml/kg－1·min－1) 17.50(14.80，19.30) 18.80(15.70，22.70) －1.230 0.219
VCO2(L/min) 1.69(1.35，1.89) 1.77(1.42，2.06) －1.535 0.125
RER 1.10(1.04，1.14) 1.18(1.12，1.23) －1.449 0.147
VO2/HR(ml/beat) 11.00(9.40，12.90) 10.60(8.80，12.40) －0.450 0.652
VE(L/min) 60.34±15.70 60.97±17.52 0.128 0.898
VT(L) 1.88±0.54 1.98±0.59 0.602 0.549
Fb(bpm) 32.53±5.04 31.61±5.90 0.559 0.578
VD/VT 0.24±0.07 0.22±0.05 1.296 0.199
ETCO2(mmHg) 34.00(31.00，37.00) 37.00(33.00，40.00) －2.755 0.006
VE/VCO2斜率 32.00(28.00，35.00) 27.00(24.00，31.00) －4.031 0.000
表3 Logistic回归分析PAL发生的危险因素
自变量 B SE(B) Walds值 OR(95%CI) P值
吸烟史 2.080 1.055 3.889 8.006(1.013~63.279) 0.049
FEV1% －2.425 1.163 4.349 0.088(0.009~0.864) 0.037
胸膜黏连 2.339 1.090 4.605 10.366(1.225~87.752) 0.032
峰值ETCO2 －0.890 0.843 1.116 0.411(0.079~2.141) 0.291
VE/VCO2斜率 3.363 1.028 10.701 28.889(3.851~216.729) 0.001
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