Brunelli Alessandro, Refai Majed, Salati Michele, Xiumé Francesco, Sabbatini Armando
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy.
Ann Thorac Surg. 2007 Mar;83(3):1134-9. doi: 10.1016/j.athoracsur.2006.11.062.
The objective of this study was to prospectively assess the agreement between predicted and observed postoperative values of forced expiratory volume in 1 second (FEV1) and carbon monoxide lung diffusion capacity (DLCO) after major lung resection.
Two hundred consecutive patients undergoing lobectomy or pneumonectomy for lung cancer in a single center were prospectively evaluated with complete preoperative and repeated postoperative measurements of FEV1 and DLCO. Predicted postoperative (ppo) values were compared with the observed postoperative values. The precision of ppoFEV1 and ppoDLCO at 3 months was subsequently evaluated by plotting the cumulative predicted postoperative values against the observed ones.
After lobectomy, observed values were 11% lower at discharge (p < 0.0001), and 6% higher at 3 months (p < 0.0001), compared with ppoFEV1. No differences were noted at 1 month. Observed DLCO values were 12% lower than predicted at discharge (p < 0.0001) and 10% higher than predicted at 3 months (p < 0.0001), without differences noted at 1 month. After pneumonectomy, no differences were noted between predicted and observed values of FEV1 at every evaluation time, and of DLCO at discharge and 1 month. However, the observed DLCO value was 17% higher than predicted at 3 months (p = 0.002). Plots of predicted and observed postoperative values at 3 months showed that ppoFEV1 predicted worse at lower levels of ppoFEV1, and ppoDLCO was constantly lower than the observed values at every ppoDLCO levels.
Given the imprecision of the prediction of postoperative function, particularly of gas exchange determinants and after pneumonectomy, and at low ppoFEV1 levels, the use of ppoFEV1 and ppoDLCO for risk stratification needs to be reconsidered.
本研究的目的是前瞻性评估肺叶切除术后1秒用力呼气容积（FEV1）和一氧化碳肺弥散量（DLCO）的预测值与观察值之间的一致性。
连续200例在单一中心因肺癌接受肺叶切除术或全肺切除术的患者接受前瞻性评估，术前进行FEV1和DLCO的完整测量，并在术后重复测量。将术后预测（ppo）值与术后观察值进行比较。随后通过绘制累积术后预测值与观察值的关系图，评估ppoFEV1和ppoDLCO在3个月时的预测精度。
肺叶切除术后，与ppoFEV1相比，出院时观察值低11%（p<0.0001），3个月时高6%（p<0.0001）。1个月时未发现差异。观察到的DLCO值出院时比预测值低12%（p<0.0001），3个月时比预测值高10%（p<0.0001），1个月时未发现差异。全肺切除术后，在每个评估时间点，FEV1的预测值与观察值之间以及出院时和1个月时DLCO的预测值与观察值之间均未发现差异。然而，观察到的DLCO值在3个月时比预测值高17%（p=0.002）。3个月时预测值与观察值的关系图显示，在较低的ppoFEV1水平下，ppoFEV1的预测效果较差，并且在每个ppoDLCO水平下，ppoDLCO始终低于观察值。
鉴于术后功能预测的不准确性，尤其是气体交换指标以及全肺切除术后和低ppoFEV1水平时，需要重新考虑使用ppoFEV1和ppoDLCO进行风险分层。
