Zibrak J D, O'Donnell C R, Marton K
New England Deaconess Hospital, Boston, Massachusetts.
Ann Intern Med. 1990 May 15;112(10):763-71. doi: 10.7326/0003-4819-112-10-763.
To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes.
MEDLINE search of English-language articles from 1966 to 1987 using the following medical subjects headings respiratory function tests, lung, lung diseases, and preoperative care.
Relevant studies were subdivided by operative site. We included only studies for which we could determine pre- and post-test probabilities of morbidity, mortality, sensitivity, and specificity. Preoperative pulmonary function testing was found to have measureable benefit in predicting outcome in lung resection candidates. In selected patients, split perfusion lung scanning and pulmonary exercise testing appeared to be useful. Confirmation of these reports is necessary before these preoperative tests can be routinely recommended. In studies of upper abdominal surgery, spirometry and arterial blood gas analysis did not consistently have measureable benefit in identifying patients at increased risk for postoperative pneumonia, prolonged hospitalization, and death. Studies of preoperative testing for other patients, including those having coronary artery bypass grafting, lacked adequate data for meaningful analysis.
Preoperative pulmonary function testing helps clinicians to make decisions on management of lung resection candidates. Although many studies of patients before abdominal surgery have focused on the utility of preoperative pulmonary function testing, methodologic difficulties undermine the validity of their conclusions. The impact of testing on care of other preoperative patients is even less clear because of poor study design and insufficient data. Therefore, further investigation is necessary before a consensus can be reached on the role of preoperative pulmonary function testing in evaluating patients before all surgical procedures except lung resection.
严格评估评估术前肺功能测试在预测术后结果中作用的原始研究。
使用以下医学主题词“呼吸功能测试”“肺”“肺部疾病”和“术前护理”，对1966年至1987年的英文文章进行医学文献数据库（MEDLINE）检索。
相关研究按手术部位细分。我们仅纳入了能够确定发病、死亡的测试前和测试后概率、敏感性和特异性的研究。术前肺功能测试在预测肺切除候选者的结果方面具有可测量的益处。在选定的患者中，分侧肺灌注扫描和肺运动测试似乎有用。在这些术前测试能够被常规推荐之前，有必要对这些报告进行证实。在上腹部手术的研究中，肺活量测定和动脉血气分析在识别术后肺炎、住院时间延长和死亡风险增加的患者方面并非始终具有可测量的益处。对其他患者（包括接受冠状动脉搭桥术的患者）术前测试的研究缺乏足够的数据进行有意义的分析。
术前肺功能测试有助于临床医生对肺切除候选者的管理做出决策。尽管许多关于腹部手术前患者的研究都集中在术前肺功能测试的效用上，但方法学上的困难削弱了其结论的有效性。由于研究设计不佳和数据不足，测试对其他术前患者护理的影响甚至更不明确。因此，在就术前肺功能测试在除肺切除之外的所有外科手术前评估患者中的作用达成共识之前，有必要进行进一步的研究。
