Lederer David J, Thomashow Byron M, Ginsburg Mark E, Austin John H M, Bartels Matthew N, Yip Chun K, Jellen Patricia A, Brogan Frances L, Kawut Steven M, Maxfield Roger A, DiMango Angela M, Simonelli Paul F, Gorenstein Lyall A, Pearson Gregory D N, Sonett Joshua R
New York Presbyterian Lung Volume Reduction Surgery Program, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
J Thorac Cardiovasc Surg. 2007 Jun;133(6):1434-8. doi: 10.1016/j.jtcvs.2006.12.062.
We hypothesized that lung-volume reduction surgery for pulmonary emphysema would improve body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index, a multidimensional predictor of survival in chronic obstructive pulmonary disease. We also aimed to identify preoperative predictors of improvement in the BODE index.
In a prospective cohort study of patients undergoing lung-volume reduction surgery at our center, with the methodology of the National Emphysema Treatment Trial, we compared clinical characteristics before and 1 year after surgery with the Wilcoxon signed rank test. Changes in the BODE index were correlated with preoperative variables with the Spearman correlation coefficient.
Twenty-three patients with predominantly upper-lobe pulmonary emphysema underwent lung-volume reduction surgery (14 by video-assisted thoracoscopic surgery, 9 by median sternotomy). There were no postoperative or follow-up deaths. The BODE index improved from a median of 5 (interquartile range 4-5) before surgery to 3 (interquartile range 2-4) 1 year after surgery (P < .0001). Improvements were seen in the lung function and dyspnea components of the BODE index. Lower preoperative 6-minute walk distance and lower postwalk Borg fatigue scores were each associated with greater improvement in the BODE index after 1 year.
Lung-volume reduction surgery for pulmonary emphysema improved the BODE index in patients with predominantly upper-lobe disease. Lower preoperative 6-minute walk distance correlated with greater improvement in the BODE index.
我们推测，针对肺气肿的肺减容手术会改善体重指数、气流阻塞、呼吸困难和运动能力（BODE）指数，该指数是慢性阻塞性肺疾病生存的多维预测指标。我们还旨在确定术前预测BODE指数改善的因素。
在我们中心进行的一项针对接受肺减容手术患者的前瞻性队列研究中，采用国家肺气肿治疗试验的方法，我们用Wilcoxon符号秩检验比较了手术前和术后1年的临床特征。BODE指数的变化与术前变量用Spearman相关系数进行关联。
23例以上叶为主的肺气肿患者接受了肺减容手术（14例通过电视辅助胸腔镜手术，9例通过正中胸骨切开术）。术后及随访期间无死亡病例。BODE指数从术前的中位数5（四分位间距4 - 5）改善至术后1年的3（四分位间距2 - 4）（P <.0001）。BODE指数的肺功能和呼吸困难部分均有改善。术前6分钟步行距离较短以及步行后Borg疲劳评分较低均与术后1年BODE指数的更大改善相关。
针对上叶为主型疾病患者的肺气肿肺减容手术改善了BODE指数。术前6分钟步行距离较短与BODE指数的更大改善相关。
