Benzo Roberto, Kelley George A, Recchi Laura, Hofman Albert, Sciurba Frank
Division of Pulmonary & Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Respir Med. 2007 Aug;101(8):1790-7. doi: 10.1016/j.rmed.2007.02.012. Epub 2007 Apr 3.
While exercise capacity, expressed as maximal oxygen consumption (VO2max), has been proposed to be the best predictor of postoperative cardiopulmonary complications after surgical resection in lung cancer patients, the literature remains controversial. The purpose of this study was to use the meta-analytic approach to determine if VO2max, expressed as either ml kg(-1) min(-1) or as a percentage of predicted, differed between patients who develop postoperative cardiopulmonary complications versus those that do not.
Studies were retrieved via (1) computerized literature searches, (2) cross referencing from retrieved articles, and (3) expert review of our reference list. Trials were included if they reported preoperative VO2max values (ml kg(-1) min(-1) or percentage of predicted) and had patients in which postoperative cardiopulmonary complications occurred.
Fourteen studies representing a total of 955 men and women met our criteria for inclusion. Across all designs and categories, random-effects modeling demonstrated that patients without postoperative pulmonary complications had significantly higher levels of VO2max in ml kg(-1) min(-1) (mean difference=3.0, 95% confidence interval (CI), 1.9-4.0) as well as VO2max as a percentage of predicted (mean difference=8, 95% CI, 3.3-12.8).
After a systematic review of the literature, we found that exercise capacity, expressed as VO2max, is lower in patients that develop clinically relevant complications after curative lung resection. These results are important for the practicing clinician because they answer the literature controversy on the usefulness of measuring preoperative exercise capacity and reinforce the current guidelines on decision making for lung resection.
虽然用最大摄氧量（VO2max）表示的运动能力被认为是肺癌患者手术切除术后心肺并发症的最佳预测指标，但文献报道仍存在争议。本研究旨在采用荟萃分析方法，确定以毫升每千克每分钟（ml kg(-1) min(-1)）或预测值百分比表示的VO2max在发生术后心肺并发症的患者与未发生者之间是否存在差异。
通过以下方式检索研究：（1）计算机文献检索，（2）对检索到的文章进行交叉引用，（3）对我们的参考文献列表进行专家评审。如果试验报告了术前VO2max值（ml kg(-1) min(-1)或预测值百分比），并且有术后发生心肺并发症的患者，则纳入试验。
14项研究共纳入955名男性和女性，符合我们的纳入标准。在所有设计和类别中，随机效应模型表明，没有术后肺部并发症的患者，以ml kg(-1) min(-1)表示的VO2max水平显著更高（平均差异=3.0，95%置信区间（CI），1.9 - 4.0），以预测值百分比表示的VO2max水平也显著更高（平均差异=8，95%CI，3.3 - 12.8）。
在对文献进行系统综述后，我们发现，在根治性肺切除术后发生临床相关并发症的患者中，以VO2max表示的运动能力较低。这些结果对临床医生很重要，因为它们解决了关于测量术前运动能力有用性的文献争议，并强化了当前肺切除决策的指南。
