肺气肿肺减容术后5年的肺功能

Lung function 5 yr after lung volume reduction surgery for emphysema.

作者信息

Gelb A F, McKenna R J, Brenner M, Epstein J D, Zamel N

机构信息

Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, University of California, Los Angeles, California, USA.

出版信息

Am J Respir Crit Care Med. 2001 Jun;163(7):1562-6. doi: 10.1164/ajrccm.163.7.2009048.

DOI:10.1164/ajrccm.163.7.2009048

PMID:11401874

Abstract

Current datum more than 2 yr after lung volume reduction surgery (LVRS) for emphysema is limited. This prospective study evaluates pre-LVRS baseline and 5-yr results in 26 symptomatic patients (mean age 67 +/- 6 yr) (mean +/- SD) who underwent bilateral, targeted upper lobe stapled LVRS using video-assisted thoracoscopy. Baseline forced expiratory volume in 1 s (FEV(1)) was 0.7 +/- 0.2 L (mean +/- SD), 29 +/- 10% predicted. Following LVRS, with none lost to follow-up, mortality due to respiratory failure at 0.5, 1, 2, 3, 4, and 5 yr was 4%, 4%, 19%, 31%, 46%, and 58%, respectively. Increase above baseline for FEV(1) > 200 ml and/or FVC > 400 ml at 1, 2, 3, 4, and 5 yr post-LVRS was noted in 73%, 46%, 35%, 27%, and 8% of all patients; decrease in dyspnea grade >/= 1 in 88%, 69%, 46%, 27%, and 15%; and elimination of initial oxygen dependence in 18 patients in 78%, 50%, 33%, 22%, and 0%, respectively. Expiratory airflow improved due to the increase in both lung elastic recoil and small airway intraluminal caliber. Five patients decreased FEV(1) 141 +/- 60 ml/yr and FVC 102 +/- 189 ml/yr over 3.8 +/- 1.2 yr post-LVRS, similar to their pre-LVRS rate of decline. In the 11 patients who survived 5 yr, at 0.5-1.0 yr post-LVRS peak increase in FEV(1) was 438 +/- 366 ml, with a decline of 149 +/- 157 ml the following year and 78 +/- 59 ml/yr over 4.0-4.5 yr. Bilateral LVRS provided palliative clinical and physiological improvement in 9 of 26 patients at 3 yr, 7 at 4 yr, and 2 at 5 yr.

摘要

关于肺气肿肺减容手术（LVRS）超过2年的当前数据有限。这项前瞻性研究评估了26例有症状患者（平均年龄67±6岁）（平均±标准差）LVRS术前基线情况及5年结果，这些患者采用电视辅助胸腔镜进行双侧、靶向性上叶钉合式LVRS。基线第1秒用力呼气容积（FEV₁）为0.7±0.2L（平均±标准差），为预计值的29±10%。LVRS后，无失访病例，0.5、1、2、3、4和5年因呼吸衰竭导致的死亡率分别为4%、4%、19%、31%、46%和58%。LVRS后1、2、3、4和5年，所有患者中FEV₁增加超过基线>200ml和/或FVC增加超过基线>400ml的比例分别为73%、46%、35%、27%和8%；呼吸困难分级降低≥1级的比例分别为88%、69%、46%、27%和15%；18例初始依赖吸氧患者中吸氧依赖消除的比例分别为78%、50%、33%、22%和0%。由于肺弹性回缩和小气道管腔内口径增加，呼气气流得到改善。5例患者在LVRS后3.8±1.2年期间FEV₁每年下降141±60ml，FVC每年下降102±189ml，与LVRS前下降速率相似。在存活5年的11例患者中，LVRS后0.5 - 1.0年FEV₁峰值增加438±366ml，次年下降149±157ml，在4.0 - 4.5年期间每年下降78±59ml。双侧LVRS使26例患者中的9例在3年时、7例在4年时、2例在5年时获得姑息性临床和生理改善。