【摘要】 目的 探讨基于峰值呼气流速（peak expiratory flow rate，PEFR）的呼吸性肌肉力量减低对I-IIIA期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者术后预后的影响。方法 回顾性分析我院2020年1月-2025年11月接受根治性手术切除的I-IIIA期NSCLC患者临床及影像资料，包括基于肺功能的PEFR（呼吸性肌肉力量指标）及胸部CT的胸肌质量指数（pectoralis muscle index, PMI）。分别采用Jonckheere-Terpstra检验、Spearman’s相关分析比较PEFR与PMI随年龄的变化规律及二者的相关性。低PEFR定义为小于PEFR的性别特异性下四分位数，进一步采用单、多因素Cox回归分析探讨PEFR及PMI对NSCLC患者术后结局的影响。结果 共纳入102例患者，中位年龄62岁（53-67岁），男性65例（63.7%），低低PEFR组24例（23.5%）。低PEFR组在年龄、FEVI、DLCO、FEV1/FVC、FVC、血清白蛋白及随访时间等方面均与正常组间存在显著差异（P＜0.05）。在男、女性患者中，PEFR均表现为随年龄增长逐渐下降的趋势；且与PMI具有较好的相关性（r=0.25，P=0.001）。单因素及多因素Cox回归分析显示，低PEFR是影响NSCLC患者术后无进展生存期（progression free survival, PFS）的独立危险因素（HR=1.57，95%CI：1.03-2.39；P=0.036）结论 呼吸性肌肉力量减低是NSCLC患者术后PFS的独立危险因素，有望成为NSCLC术后复发的早期生物学标志物。

【Abstract】 Objective To investigate the impact of reduced respiratory muscle strength, assessed by peak expiratory flow rate (PEFR), on postoperative outcomes in patients with stage I-IIIA non-small cell lung cancer (NSCLC). Methods Clinical and imaging data of patients with stage I-IIIA NSCLC who underwent radical resection at our hospital from January 2020 to November 2025 were retrospectively analyzed, including PEFR (an indicator of respiratory muscle strength) based on pulmonary function tests and the pectoralis muscle index (PMI) derived from chest CT. The Jonckheere-Terpstra test and Spearman’s correlation analysis were used to evaluate age-related changes in PEFR and PMI and their correlation, respectively. Low PEFR was defined as values below the sex-specific lower quartile of PEFR. Univariate and multivariate Cox regression analyses were performed to assess the impact of PEFR and PMI on postoperative prognosis in NSCLC patients.Results A total of 102 patients were enrolled, with a median age of 62 years (range 53-67 years); 65 patients (63.7%) were male, and 24 (23.5%) were classified into the low PEFR group. The low PEFR group showed significant differences from the normal PEFR group in age, FEV1, DLCO, FEV1/FVC, FVC, serum albumin, and follow-up duration (all P < 0.05). In both male and female patients, PEFR progressively decreased with age and was positively correlated with PMI (r = 0.25, P = 0.001). Univariate and multivariate Cox regression analyses identified low PEFR as an independent risk factor for postoperative progression-free survival (PFS) in NSCLC patients (HR = 1.57, 95% CI: 1.03–2.39; P = 0.036).Conclusion Reduced respiratory muscle strength is an independent risk factor for postoperative PFS in NSCLC patients and may serve as an early biomarker for postoperative recurrence.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.