在胸段食管鳞状细胞癌患者运动试验期间使用呼出气体分析对心肺储备进行术前评估。

Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.

作者信息

Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T

机构信息

Department of Surgery, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi Yahatahigashi-ku Kitakyushu City, 805-8527, Japan.

出版信息

J Thorac Cardiovasc Surg. 2001 Jun;121(6):1064-8. doi: 10.1067/mtc.2001.113596.

DOI:10.1067/mtc.2001.113596

PMID:11385372

Abstract

OBJECTIVE

We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma.

BACKGROUND DATA

Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications. To reduce the surgical risk, we performed preoperative risk analysis using 8 factors. Although hospital mortality was decreased when this risk analysis was used, severe cardiopulmonary complications still occurred.

METHODS

The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy. The maximum oxygen uptake, anaerobic threshold, vital capacity, percent vital capacity, forced expiratory volume in 1 second, percent forced expiratory volume, V.(25)/HT, forced expired flow at 75% of forced vital capacity to height ratio (FEF(75%)/HT), forced expired flow at 50% to 75% of forced vital capacity ratio (FEF(50%)/FEF(75%)), percent diffusion capacity for carbon monoxide, and arterial oxygen tension were measured. Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications.

RESULTS

Only the maximum oxygen uptake was significantly different between the 2 groups. All patients were grouped according to the value of the maximum oxygen uptake, and the occurrence of postoperative cardiopulmonary complications was calculated for each group. A cardiopulmonary complication rate of 86% was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1). m(-2); for those with a value of 700 to 799 mL. min(-1). m(-2), the complication rate was 44%.

CONCLUSIONS

The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate. On the basis of these results, esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1). m(-2).

摘要

目的

我们评估了运动试验期间分析呼出气体对预测食管癌患者术后心肺并发症的有用性。

背景数据

胸段食管癌患者需行根治性食管切除术加三野淋巴结清扫术，但术后并发症风险较高。为降低手术风险，我们使用8个因素进行术前风险分析。尽管使用该风险分析后医院死亡率有所下降，但严重心肺并发症仍有发生。

方法

研究组由91例行根治性食管切除术加三野淋巴结清扫术的患者组成。测量最大摄氧量、无氧阈值、肺活量、肺活量百分比、一秒用力呼气量、用力呼气量百分比、V.(25)/HT、用力肺活量75%时的用力呼气流量与身高之比（FEF(75%)/HT）、用力肺活量50%至75%时的用力呼气流量之比（FEF(50%)/FEF(75%)）、一氧化碳弥散量百分比和动脉血氧张力。根据术后心肺并发症的有无将患者分为两组。