Puri Varun, Zoole Jennifer B, Musick Joanne, Krupnick Alexander S, Kreisel Daniel, Crabtree Traves D, Patterson G Alexander, Meyers Bryan F
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Innovations (Phila). 2011 Jul;6(4):257-61. doi: 10.1097/IMI.0b013e31822a3709.
To compare handheld office spirometry with laboratory spirometry in evaluation of low-risk patients undergoing pulmonary resection.
Low-risk patients evaluated for lung resection were enrolled in a prospective study and underwent office and laboratory spirometry. Standard laboratory spirometry values were considered the gold standard. Values of forced expiratory volume in 1 second (FEV1) <1.5 L or FEV1% <60% were determined in advance to signal high risk.
Thirty patients with mean age 64 ± 12 years and median Karnofsky performance status 100 (80-100) were evaluated. The mean FEV1-office spirometry and mean FEV1-laboratory spirometry were comparable (2.14 L vs 2.36 L) as were the mean FEV1%-office spirometry and FEV1%-laboratory spirometry (78% vs 85%). The differences were within limits established a priori. Laboratory spirometry identified 3 of 30 (10%) patients as high risk and office spirometry identified 5 of 30 (16%) patients as high risk, including the 3 patients identified by laboratory spirometry. The sensitivity of office spirometry for detecting high risk was 100% (3/3) and specificity was 93% (25/27). The negative predictive value of office spirometry was 100% (25/25). Office spirometry added a median of 1 minute to the office visit, whereas laboratory spirometry added 42 minutes. Eventually, 25 of 30 (83%) patients underwent lung resection. There were 12 lobar and 13 sublobar resections. One patient developed postoperative respiratory morbidity. This patient was high risk by office spirometry but not by laboratory spirometry. This patient was discharged on home oxygen.
Office spirometry FEV1 and FEV1% are clinically comparable to formal laboratory spirometry values. Office Spirometry saves time and possibly expense in the preoperative workup of patients evaluated for lung resection.
比较手持式门诊肺功能仪与实验室肺功能仪在评估低风险肺切除患者中的应用。
将接受肺切除评估的低风险患者纳入一项前瞻性研究，并进行门诊和实验室肺功能检查。标准实验室肺功能检查值被视为金标准。预先确定一秒用力呼气容积（FEV1）<1.5 L或FEV1%<60%的值表示高风险。
评估了30例平均年龄64±12岁、卡诺夫斯基功能状态中位数为100（80 - 100）的患者。门诊肺功能仪测得的平均FEV1与实验室肺功能仪测得的平均FEV1相当（2.14 L对2.36 L），门诊肺功能仪测得的平均FEV1%与实验室肺功能仪测得的平均FEV1%也相当（78%对85%）。差异在预先设定的范围内。实验室肺功能检查将30例患者中的3例（10%）识别为高风险，门诊肺功能检查将30例患者中的5例（16%）识别为高风险，其中包括实验室肺功能检查识别出的3例患者。门诊肺功能检查检测高风险的敏感性为100%（3/3），特异性为93%（25/27）。门诊肺功能检查的阴性预测值为100%（25/25）。门诊肺功能检查使门诊就诊时间平均增加1分钟，而实验室肺功能检查增加42分钟。最终，30例患者中有25例（83%）接受了肺切除。其中有12例肺叶切除和13例肺段以下切除。1例患者出现术后呼吸并发症。该患者经门诊肺功能检查为高风险，但经实验室肺功能检查不是。该患者出院时携带家庭用氧。
门诊肺功能仪测得的FEV1和FEV1%在临床上与正式的实验室肺功能检查值相当。门诊肺功能检查在接受肺切除评估患者的术前检查中节省时间且可能节省费用。
