Wang Jeng-Shing, Abboud Raja T, Wang Lee-Min
MSc, 166 Min-Shiang St, Kaohsiung, Taiwan.
Chest. 2006 Apr;129(4):863-72. doi: 10.1378/chest.129.4.863.
To evaluate the effect of lung resection on lung function and exercise capacity values, including diffusion capacity of the lung for carbon monoxide (Dlco), during exercise, and to determine whether postoperative lung function, including exercise capacity and Dlco during exercise, could be predicted from preoperative lung function and the number of functional segments resected.
Prospective study.
Clinical pulmonary function laboratory in a university teaching hospital.
Twenty-eight patients undergoing lung resection at Vancouver General Hospital from October 1998 to May 1999, were studied preoperatively and 1-year postoperatively.
We determined FEV(1) and FVC, and maximal oxygen uptake (Vo(2)max) and maximal workload (Wmax) achieved during incremental exercise testing. We used the three-equation modification of the single-breath Dlco technique to determine Dlco at rest (RDlco) and during steady-state exercise at 70% of Wmax, and the increase in Dlco from rest to exercise (ie, the mean increase in Dlco percent predicted at 70% of Wmax from resting Dlco percent predicted [(70%-R)Dlco]). We calculated the predicted postoperative (PPO) values for all the above parameters using the preoperative test data and the extent of functioning bronchopulmonary segments resected, and compared the results with the actual 1-year postoperative results.
Following lung resection, there was a significant reduction in FEV(1), FVC, and Dlco with decreases of 12%, 13%, and 22% predicted, respectively. There were also significant decreases in Vo(2)max per kilogram of 2.1 mL/min/kg (8% of predicted Vo(2)max) and in Wmax of 12 W (7% of predicted Wmax). However, (70%-R)Dlco did not significantly decrease after lobectomy but decreased after pneumonectomy. The calculated PPO values significantly underestimated postoperative values after pneumonectomy but were acceptable for lobectomy.
Exercise tests may be better indicators of functional capacity after lung resection than measurements of FEV(1) and FVC or RDlco. PPO results calculated by estimating the functional contribution of the resected segments, are comparable with those obtained using ventilation-perfusion lung scanning and significantly underestimate postoperative lung function after pneumonectomy, but are acceptable for lobectomy.
评估肺切除对肺功能和运动能力指标的影响，包括运动期间的一氧化碳弥散量（Dlco），并确定能否根据术前肺功能和切除的功能肺段数量预测术后肺功能，包括运动能力和运动期间的Dlco。
前瞻性研究。
一所大学教学医院的临床肺功能实验室。
1998年10月至1999年5月在温哥华总医院接受肺切除的28例患者，于术前及术后1年进行研究。
我们测定了第1秒用力呼气量（FEV(1)）和用力肺活量（FVC），以及递增运动试验期间达到的最大摄氧量（Vo(2)max）和最大负荷量（Wmax）。我们采用单呼吸Dlco技术的三方程修正法来测定静息时的Dlco（RDlco）以及在Wmax的70%稳态运动期间的Dlco，并计算从静息到运动时Dlco的增加量（即，在Wmax的70%时预测的Dlco增加百分比相对于静息时预测的Dlco百分比[(70%-R)Dlco]）。我们使用术前测试数据和切除的功能性支气管肺段范围计算上述所有参数的术后预测（PPO）值，并将结果与术后1年的实际结果进行比较。
肺切除术后，FEV(1)、FVC和Dlco显著降低，预测值分别下降了12%、13%和22%。每千克体重的Vo(2)max也显著下降了2.1 mL/min/kg（为预测Vo(2)max的8%），Wmax下降了12 W（为预测Wmax的7%）。然而，(70%-R)Dlco在肺叶切除术后没有显著下降，但在全肺切除术后下降了。计算得到的PPO值在全肺切除术后显著低估了术后值，但在肺叶切除术后是可接受的。
运动试验可能比FEV(1)、FVC或RDlco测量更能准确反映肺切除术后的功能能力。通过估计切除肺段的功能贡献计算得到的PPO结果，与使用通气灌注肺扫描获得的结果相当，并且在全肺切除术后显著低估了术后肺功能，但在肺叶切除术后是可接受的。
