Wilkens H, Demertzis S, König J, Leitnaker C K, Schäfers H J, Sybrecht G W
Innere Medizin V, Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
Eur Respir J. 2000 Dec;16(6):1043-9. doi: 10.1034/j.1399-3003.2000.16f04.x.
Lung volume reduction surgery (LVRS) has been proposed for patients with severe emphysema to improve dyspnoea and pulmonary function. It is unknown, however, whether prognosis and pulmonary function in these patients can be improved compared to conservative treatment. The effect of LVRS and conservative therapy were compared prospectively in 57 patients with emphysema, who fulfilled the standard criteria for LVRS. The patients were divided into two groups according to their own decision. Patients in group 1 (n=29, eight females, mean+/-SEM 58.8+/-1.7 yrs, forced expiratory volume in one second (FEV1) 27.6+/-1.3% of the predicted value) underwent LVRS. Patients in group 2 (n=28, five females, 58.5+/-1.8 yrs, FEV1 30.8+/-1.4% pred) preferred to postpone LVRS. There were no significant differences in lung function between the two groups at baseline; however, there was a tendency towards better functional status in the control group. The control group had a better modified Medical Research Council (MMRC) dyspnea score (3.1+/-0.15 versus 3.5+/-0.1, p<0.04). Model-based comparisons were used to estimate the differences between the two groups over 18 months. Significant improvements were observed in the LVRS group compared to the control group in FEV1, total lung capacity (TLC), Residual volume (RV), MMRC dyspnea score and 6-min walking distance on all follow up visits. The estimated difference in FEV1 was 33% (95% confidence interval 13-58%; p>0.0001), in TLC 12.9% (7.9-18.8%; p>0.0001), in RV 60.9% 32.6-89.2%; p>0.0001), in 6-min walking distance 230 m (138-322 m; p<0.002) and in MMRC dyspnoea score 1.17 (0.79-1.55; p<0.0001). In conclusion, lung volume reduction surgery is more effective than conservative treatment for the improvement of dyspnoea, lung function and exercise capacity in selected patients with severe emphysema.
肺减容手术（LVRS）已被推荐用于重度肺气肿患者，以改善呼吸困难和肺功能。然而，与保守治疗相比，这些患者的预后和肺功能是否能得到改善尚不清楚。我们对57例符合LVRS标准的肺气肿患者进行了前瞻性研究，比较了LVRS和保守治疗的效果。患者根据自己的决定分为两组。第1组患者（n = 29，8名女性，平均年龄±标准误58.8±1.7岁，一秒用力呼气容积（FEV1）为预测值的27.6±1.3%）接受了LVRS。第2组患者（n = 28，5名女性，58.5±1.8岁，FEV1为预测值的30.8±1.4%）倾向于推迟LVRS。两组患者基线时肺功能无显著差异；然而，对照组的功能状态有更好的趋势。对照组的改良医学研究委员会（MMRC）呼吸困难评分更好（3.1±0.15对3.5±0.1，p < 0.04）。采用基于模型的比较方法来估计两组在18个月内的差异。在所有随访中，LVRS组与对照组相比，FEV1、肺总量（TLC）、残气量（RV）、MMRC呼吸困难评分和6分钟步行距离均有显著改善。FEV1的估计差异为33%（95%置信区间13 - 58%；p > 0.0001），TLC为12.9%（7.9 - 18.8%；p > 0.0001），RV为60.9%（32.6 - 89.2%；p > 0.0001），6分钟步行距离为230米（138 - 322米；p < 0.002），MMRC呼吸困难评分为1.17（0.79 - 1.55；p < 0.0001）。总之，对于部分重度肺气肿患者，肺减容手术在改善呼吸困难、肺功能和运动能力方面比保守治疗更有效。
