Westhoff M
Klinik für Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer, Hemer.
Pneumologie. 2007 Apr;61(4):256-63. doi: 10.1055/s-2007-959195.
Preoperative risk stratification for lung surgery requires the determination of FEV1 and TLCO. Calculation of relative values and predective postoperative values in dependence on the extent of resection is preferable in comparison to absolute values. National and international guidelines have different recommendations for preoperative functional assessment. In general they recommend cardiopulmonary exercise testing if preoperative FEV1 and TLCO are < 80%-pred. or if ppo values are < 40%-pred. Inoperability is assumed if ppo values of V'O2-max are < 10 ml/kg/min or < 35%-pred. On this basis, a more simplified algorithm for the preoperative assessment of candidates for lung resection (Hemer algorithm) is presented. Nevertheless, there still remain some unresolved questions. These concern the assessment of the individual operative risk of patients who are at or just beyond the limits of functional operability. Furthermore, there is the fact that patients - in spite of a severe functional impairment - are willing to accept a higher risk of morbidity and mortality, especially if there is a curative option.
肺手术的术前风险分层需要测定第一秒用力呼气容积（FEV1）和肺一氧化碳弥散量（TLCO）。与绝对值相比，根据切除范围计算相对值和预测术后值更为可取。国内和国际指南对术前功能评估有不同的建议。一般来说，如果术前FEV1和TLCO<预测值的80%，或者术后预测值<预测值的40%，他们建议进行心肺运动试验。如果最大摄氧量（V'O2-max）的术后预测值<10 ml/kg/min或<预测值的35%，则认为无法手术。在此基础上，提出了一种更简化的肺切除候选者术前评估算法（赫默算法）。然而，仍然存在一些未解决的问题。这些问题涉及对处于功能可手术性极限或刚刚超过该极限的患者个体手术风险的评估。此外，还有一个事实是，尽管功能严重受损，但患者愿意接受更高的发病和死亡风险，尤其是如果有治愈性选择的话。
