Ferguson Mark K, Gaissert Henning A, Grab Joshua D, Sheng Shubin
Department of Surgery, University of Chicago, Chicago, IL 60637, USA.
J Thorac Cardiovasc Surg. 2009 Dec;138(6):1297-302. doi: 10.1016/j.jtcvs.2009.05.045. Epub 2009 Sep 26.
Diffusing capacity is not routinely used in assessing risk of lung resection, perhaps owing to uncertainty as to whether patients with normal spirometric results require additional evaluation. We determined whether diffusing capacity is predictive of pulmonary complications after lung resection in patients with normal spirometric results.
We reviewed outcomes of major lung resection in The Society of Thoracic Surgeons General Thoracic Surgery Database from 2002 to 2008 to determine the relationship of diffusing capacity (expressed as percent of predicted) to postoperative pulmonary complications stratified by chronic obstructive pulmonary disease status.
Percent of predicted diffusing capacity was measured in 7891 (57%) patients. There were 3905 women and 3986 men with a mean age of 66.3 +/- 10.6 years who underwent lobectomy (6904; 87.5%), bilobectomy (463; 5.9%), and pneumonectomy (524; 6.6%). Chronic obstructive pulmonary disease was identified in 2711 (34.4%) patients. Pulmonary complications occurred in 13%, and the operative mortality was 1.9%. Percent of predicted diffusing capacity was strongly associated with the development of pulmonary complications (odds ratio, 1.12 per 10-point decrease; P < .0001). Decreasing percent of predicted diffusing capacity was incrementally related to an increased incidence of pulmonary complications regardless of chronic obstructive pulmonary disease status. There was no apparent interaction between percent of predicted diffusing capacity and chronic obstructive pulmonary disease status in the predictive model.
Percent of predicted diffusing capacity predicts pulmonary complications after lung resection in patients without chronic obstructive pulmonary disease. We recommend measurement of diffusing capacity in lung resection candidates, regardless of chronic obstructive pulmonary disease, as an important element in the accurate assessment of operative risk.
弥散功能在评估肺切除风险时未被常规使用，这可能是由于对于肺功能测定结果正常的患者是否需要额外评估存在不确定性。我们确定了弥散功能是否能预测肺功能测定结果正常的患者肺切除术后的肺部并发症。
我们回顾了2002年至2008年胸外科医师协会普通胸外科数据库中主要肺切除的结果，以确定弥散功能（以预测值的百分比表示）与按慢性阻塞性肺疾病状态分层的术后肺部并发症之间的关系。
对7891例（57%）患者测量了预测弥散功能百分比。其中有3905名女性和3986名男性，平均年龄为66.3±10.6岁，接受了肺叶切除术（6904例；87.5%）、双肺叶切除术（463例；5.9%）和全肺切除术（524例；6.6%）。2711例（34.4%）患者被诊断为慢性阻塞性肺疾病。肺部并发症发生率为13%，手术死亡率为1.9%。预测弥散功能百分比与肺部并发症的发生密切相关（比值比，每降低10个百分点为1.12；P<0.0001）。无论慢性阻塞性肺疾病状态如何，预测弥散功能百分比的降低与肺部并发症发生率的增加呈递增关系。在预测模型中，预测弥散功能百分比与慢性阻塞性肺疾病状态之间没有明显的相互作用。
预测弥散功能百分比可预测无慢性阻塞性肺疾病患者肺切除术后的肺部并发症。我们建议，无论患者是否患有慢性阻塞性肺疾病，对拟行肺切除术的患者都应测量弥散功能，作为准确评估手术风险的重要因素。
