Gerson M C, Hurst J M, Hertzberg V S, Baughman R, Rouan G W, Ellis K
Department of Internal Medicine, University of Cincinnati Medical Center, Ohio.
Am J Med. 1990 Feb;88(2):101-7. doi: 10.1016/0002-9343(90)90456-n.
Major cardiac and pulmonary complications associated with abdominal and noncardiac thoracic surgery are a common cause of mortality and serious morbidity in elderly patients. We postulated that a simple, inexpensive bicycle exercise test could provide objective documentation of cardiopulmonary reserve and, therefore, predict perioperative pulmonary as well as cardiac complications.
Prior to elective surgery, 177 patients aged 65 years or older had assessment of the clinical history, results of physical examination, electrocardiogram, chest radiograph, blood chemistries, pulmonary function test findings, supine exercise test results, Dripps classification, and Goldman cardiac risk factors. Observations in patients with and without major perioperative cardiac and/or pulmonary complications were compared using univariate analysis followed by a multivariate logistic regression procedure.
Major perioperative complications were pulmonary in 24 patients, cardiac in 25 patients, and either cardiac or pulmonary in 39 patients. By multivariate analysis, inability to perform two minutes of supine bicycle exercise raising the heart rate above 99 beats/minute was the best predictor of perioperative pulmonary, cardiac, and combined cardiopulmonary complication (p less than 0.0005). Among 108 patients who were able to achieve these exercise criteria, cardiac or pulmonary complications occurred in 10 patients (9.3%), with one death (0.9%). Among 69 patients unable to exercise satisfactorily, cardiac or pulmonary complications occurred in 29 patients (42%), with five total deaths (7.2%).
Objective measurement of exercise capacity by supine bicycle ergometry appears to be of clinical value for preoperative risk stratification for both pulmonary and cardiac complications prior to major elective abdominal or noncardiac thoracic surgery in elderly patients.
与腹部及非心脏胸部手术相关的主要心脏和肺部并发症是老年患者死亡和严重发病的常见原因。我们推测，一项简单、廉价的自行车运动试验能够提供心肺储备的客观证据，从而预测围手术期的肺部及心脏并发症。
在择期手术前，对177例65岁及以上的患者进行了临床病史、体格检查结果、心电图、胸部X光片、血液化学检查、肺功能测试结果、仰卧运动试验结果、Dripps分类以及Goldman心脏危险因素的评估。采用单因素分析，随后进行多因素逻辑回归程序，比较了有和没有主要围手术期心脏和/或肺部并发症患者的观察结果。
主要围手术期并发症中，肺部并发症24例，心脏并发症25例，心脏或肺部并发症39例。通过多因素分析，无法在仰卧位进行两分钟自行车运动使心率超过99次/分钟是围手术期肺部、心脏及心肺联合并发症的最佳预测指标（p<0.0005）。在108例能够达到这些运动标准的患者中，10例（9.3%）发生了心脏或肺部并发症，1例死亡（0.9%）。在69例无法令人满意地进行运动的患者中，29例（42%）发生了心脏或肺部并发症，共5例死亡（7.2%）。
对于老年患者在择期进行腹部或非心脏胸部大手术前，通过仰卧位自行车测力计客观测量运动能力似乎对术前肺部和心脏并发症的风险分层具有临床价值。
