Varela Gonzalo, Brunelli Alessandro, Rocco Gaetano, Marasco Rita, Jiménez Marcelo F, Sciarra Valeria, Aranda José Luis, Gatani Tindaro
Service of Thoracic Surgery. Salamanca University Hospital, 37007 Salamanca, Spain.
Eur J Cardiothorac Surg. 2006 Oct;30(4):644-8. doi: 10.1016/j.ejcts.2006.07.001. Epub 2006 Aug 8.
Scanty information can be found regarding ppoFEV1% correlation with true FEV1% in the immediate days after surgery, when most cardio-respiratory complications are developed. This prospective multicentric investigation aims to describe the evolution of FEV1 in a series of uneventful lobectomy cases before hospital discharge, and to identify factors associated with the variation of postoperative residual FEV1, with the ratio between the actual and the predicted postoperative FEV1 measured during the first 6 postoperative days.
One hundred and sixty-one patients submitted to lobectomy were prospectively enrolled in the study. Patients with chest wall resections and postoperative complications were excluded. Data from a total of 125 patients were thus used for the analysis. The following clinical variables were recorded: age, preoperative FEV1, ppoFEV1, presence of chronic obstructive pulmonary disease (COPD), surgical approach (VATS or muscle-sparing thoracotomy), side (right or left) and site (upper or lower) of resection, type of analgesia (epidural or intravenous), and daily visual analogue pain score (VAS). FEV1 was measured in every patient at hospital admission and daily until discharge or up to postoperative day 6. Random effects time-series cross-sectional regression analyses were performed to identify factors associated with variation of postoperative residual function (100-(preoperative FEV1-postoperative FEV1/preoperative FEV1 x 100)), and of FEV1 ratio ((actual postoperative FEV1 x 100)/ppoFEV1). For these analyses, the dependent variables (postoperative residual function and FEV1 ratio) and the pain score were analysed as panel longitudinal data. The regression analyses were subsequently validated by bootstrap procedure.
FEV1% was lower at first postoperative day and increased gradually up to day 6 but mean values never reached ppoFEV1%. Pain scores decreased from day 1 to day 6. Preoperative FEV1 (p<0.0001) and postoperative pain score (p<0.0001) resulted independently and reliably inversely associated with postoperative residual FEV1 (model R2, 0.16). Preoperative FEV1 (p=0.001), postoperative pain score (p<0.0001), and epidural analgesia (p=0.04) resulted independently and reliably associated with postoperative FEV1 ratio (model R2, 0.13).
Current methods of prediction of postoperative FEV1 greatly underestimated the real functional loss in the immediate postoperative period. Therefore, for the purpose of a more accurate risk stratification we need to correct the traditional prediction of postoperative FEV1.
在术后数天内，当大多数心肺并发症出现时，关于ppoFEV1%与真实FEV1%之间的相关性信息很少。这项前瞻性多中心研究旨在描述一系列无并发症肺叶切除病例出院前FEV1的变化情况，并确定与术后残余FEV1变化相关的因素，以及术后第1至6天实际与预测术后FEV1的比值。
161例行肺叶切除术的患者前瞻性纳入本研究。排除胸壁切除术患者及术后有并发症的患者。因此，共125例患者的数据用于分析。记录以下临床变量：年龄、术前FEV1、ppoFEV1、慢性阻塞性肺疾病（COPD）的存在情况、手术方式（电视辅助胸腔镜手术或保留肌肉的开胸手术）、切除侧（右或左）和部位（上叶或下叶）、镇痛类型（硬膜外或静脉）以及每日视觉模拟疼痛评分（VAS）。每位患者在入院时及每日测量FEV1，直至出院或术后第6天。进行随机效应时间序列横断面回归分析，以确定与术后残余功能变化（100 -（术前FEV1 - 术后FEV1/术前FEV1×100））以及FEV1比值（（实际术后FEV1×100）/ppoFEV1）相关的因素。对于这些分析，将因变量（术后残余功能和FEV1比值）以及疼痛评分作为面板纵向数据进行分析。随后通过自助法对回归分析进行验证。
术后第1天FEV1%较低，至第6天逐渐升高，但平均值从未达到ppoFEV1%。疼痛评分从第1天至第6天下降。术前FEV1（p<0.0001）和术后疼痛评分（p<0.0001）与术后残余FEV1独立且可靠地呈负相关（模型R2，0.16）。术前FEV1（p = 0.001）、术后疼痛评分（p<0.0001）和硬膜外镇痛（p = 0.04）与术后FEV1比值独立且可靠地相关（模型R2，0.13）。
目前预测术后FEV1的方法在术后即刻大大低估了实际功能损失。因此，为了进行更准确的风险分层，我们需要校正传统的术后FEV1预测。
