减重手术前肺功能测试的价值。
The value of pulmonary function testing prior to bariatric surgery.
作者信息
Hamoui Nahid, Anthone Gary, Crookes Peter F
机构信息
Department of Surgery, University of Southern California, Los Angeles, CA 90033, USA.
出版信息
Obes Surg. 2006 Dec;16(12):1570-3. doi: 10.1381/096089206779319356.
BACKGROUND
Pulmonary function tests (PFTs) are often abnormal in the morbidly obese and improve after bariatric surgery. Our aim was to determine the utility of obtaining preoperative PFTs in assessing postoperative risk.
METHODS
146 consecutive patients undergoing open bariatric surgery were analyzed. Patients were divided into those who had postoperative complications (Group A, n=27) and those who did not (Group B, n=119). PFTs and BMI were compared between Groups A and B. PFT parameters are reported as the median percentage of age-matched controls.
RESULTS
Patients in Group A compared to Group B were heavier (BMI 58 vs 51 kg/m(2), P=.001) and older (46 vs 40 years, P=.02) than those in group B. They had reduced forced vital capacity (80% vs 97%, P<.001) and forced expiratory volume in 1 second (84% vs 99%, P=.002). They also had reduced vital capacity (VC, 85% vs 102%, P<.001) and total lung capacity (89% vs 99%, P=.01). They had decreased maximal voluntary ventilation (93% vs 106%, P=.003). They had lower arterial pO(2) (76 mmHg vs 85 mmHg, P=.001) and higher arterial-alveolar gradient (23 vs 17, P=.007). The strongest predictors of postoperative complications on multivariate analysis were reduced VC (RR 2.29 for each 10% decrease in VC, P=.0007) and age (RR 6.4 for age >40 years, P=.01).
CONCLUSIONS
PFTs help to predict complications after bariatric surgery. The greatest reduction in VC may occur in patients with central obesity, reflecting increased intrabdominal pressure and diminished chest wall compliance.
背景
病态肥胖患者的肺功能测试（PFTs）通常异常，且在减肥手术后会有所改善。我们的目的是确定术前进行PFTs对评估术后风险的作用。
方法
对146例连续接受开放性减肥手术的患者进行分析。患者被分为术后有并发症的患者（A组，n = 27）和无并发症的患者（B组，n = 119）。比较A组和B组之间的PFTs和BMI。PFT参数报告为年龄匹配对照组的中位数百分比。
结果
与B组相比，A组患者更重（BMI分别为58 vs 51 kg/m²，P = 0.001）且年龄更大（46 vs 40岁，P = 0.02）。他们的用力肺活量降低（80% vs 97%，P < 0.001），第1秒用力呼气量降低（84% vs 99%，P = 0.002）。他们的肺活量（VC，85% vs 102%，P < 0.001）和肺总量也降低（89% vs 99%，P = 0.01）。他们的最大自主通气量降低（93% vs 106%，P = 0.003）。他们的动脉血氧分压较低（76 mmHg vs 85 mmHg，P = 0.001），动脉-肺泡氧分压差较高（23 vs 17，P = 0.007）。多因素分析中术后并发症的最强预测因素是VC降低（VC每降低10%，相对危险度为2.29，P = 0.0007）和年龄（年龄>40岁，相对危险度为6.4，P = 0.01）。
结论
PFTs有助于预测减肥手术后的并发症。中心性肥胖患者的VC可能下降最为明显，这反映了腹内压升高和胸壁顺应性降低。
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