Schuurmans Macé M, Diacon Andreas H, Bolliger Chris T
Department of Internal Medicine, Lung Unit, University of Stellenbosch, Tygerberg Campus, Cape Town, South Africa.
Clin Chest Med. 2002 Mar;23(1):159-72. doi: 10.1016/s0272-5231(03)00066-2.
Advances in operative technique and perioperative care have reduced surgical morbidity and mortality considerably after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Patients with normal or only slightly impaired pulmonary function (FEV1 and DLCO > or = 80% predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these methods are recommended. Cardiopulmonary exercise testing, most frequently performed as a symptom-limited test with the measurement of VO2max, assesses the pulmonary and cardiovascular reserves. A VO2max of less than 10 mL/kg/minute generally is considered prohibitive for any resection, a value of greater than 20 mL/kg/minute or greater than 75% predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the ppo values of various parameters. The currently used ppo parameters are FEV1-ppo, DLCO-ppo, and VO2max-ppo. Suggested cutoff values for safe resection are: FEV1-ppo and DLCO-ppo 40% or greater than predicted, and V(r)O2max-ppo 35% or greater than predicted, combined with an absolute value of greater than or equal to 10 mL/kg/minute. The lowest acceptable ppo values remain to be confirmed by additional prospective studies. Resections involving not more than one lobe usually lead to an early functional deficit followed by recovery. The permanent loss in pulmonary function is small (approximately 10%) and exercise capacity is reduced only slightly or not at all. Pneumonectomy leads to an early permanent loss of about 33% in pulmonary function and approximately 20% in exercise capacity. Pulmonary function tests alone therefore overestimate the functional loss after lung resection.
手术技术和围手术期护理的进步已显著降低了肺切除术后的手术发病率和死亡率。人们提出了各种单一和综合的功能可操作性参数来评估手术风险。肺功能正常或仅轻度受损（FEV1和DLCO≥预测值的80%）且无心血管危险因素的患者，在无需进一步检查的情况下可接受直至全肺切除术的肺切除手术。对于其他患者，建议进行运动测试、肺功能分离研究或这些方法的联合应用。心肺运动测试，最常作为症状限制性测试进行，同时测量VO2max，可评估肺和心血管储备功能。VO2max小于10 mL/kg/分钟通常被认为对任何切除术都具有禁忌性，大于20 mL/kg/分钟或大于预测正常值的75%则对大手术是安全的。功能分离研究是基于放射性核素对各种参数ppo值的估计。目前使用的ppo参数是FEV1-ppo、DLCO-ppo和VO2max-ppo。安全切除的建议临界值为：FEV1-ppo和DLCO-ppo为预测值的40%或更高，V(r)O2max-ppo为预测值的35%或更高，同时绝对值大于或等于10 mL/kg/分钟。最低可接受的ppo值仍有待更多前瞻性研究来证实。涉及不超过一个肺叶的切除术通常会导致早期功能缺陷，随后恢复。肺功能的永久性损失较小（约10%），运动能力仅略有下降或根本没有下降。全肺切除术会导致肺功能早期永久性损失约33%，运动能力下降约20%。因此，仅靠肺功能测试会高估肺切除术后的功能损失。
