Pelletier C, Lapointe L, LeBlanc P
Centre de Pneumologie, Hôpital Laval, Ste-Foy, Québec, Canada.
Thorax. 1990 Jul;45(7):497-502. doi: 10.1136/thx.45.7.497.
The effects of lung resection on exercise capacity and perception of symptoms were studied in 47 patients aged 39-73 (mean 58.3) years. Twenty had a pneumonectomy and 27 a lobectomy, all for lung cancer. Forced expiratory volume, maximal inspiratory and expiratory pressures, and progressive maximal one minute incremental cycle ergometer exercise performance were measured before and after surgery. Breathlessness and leg discomfort were assessed with a modified Borg scale (0-10). Mean FEV1 decreased from 79% (SD 22%) to 53% (11%) of the predicted value after pneumonectomy and from 89% (22%) to 74% (18%) after lobectomy. Exercise capacity, measured as the highest work load completed, Wmax, decreased from 78% (25%) to 58% (28%) predicted in the pneumonectomy group and from 77% (21%) to 67% (20%) in the lobectomy group. There was only a weak relation between changes in FEV1 and changes in Wmax (r = 0.54, r2 = 0.30). The slope of the relation between the intensity of dyspnoea and work load or the intensity of dyspnoea and ventilation increased significantly after pneumonectomy, but not after lobectomy. Leg discomfort increased more rapidly when related to work load after both pneumonectomy and lobectomy. After resection dyspnoea was rarely the only limiting factor at maximal exercise. It is concluded that (1) change in FEV1 is a poor predictor of change in exercise capacity after lung resection; (2) pneumonectomy results in a 25% decrease in Wmax and in an appreciable increase in dyspnoea during exercise; (3) lobectomy has little or no effect on Wmax or the intensity of postoperative dyspnoea; (4) after both pneumonectomy and lobectomy leg discomfort makes an important contribution to exercise limitation.
对47名年龄在39 - 73岁（平均58.3岁）的患者进行了肺切除对运动能力和症状感知影响的研究。其中20例行全肺切除术，27例行肺叶切除术，均为肺癌患者。术前和术后测量了用力呼气量、最大吸气和呼气压力以及递增负荷运动试验中最大1分钟运动表现。采用改良的Borg量表（0 - 10）评估呼吸困难和腿部不适。全肺切除术后，平均第一秒用力呼气量（FEV1）从预测值的79%（标准差22%）降至53%（11%）；肺叶切除术后从89%（22%）降至74%（18%）。以完成的最高工作量（Wmax）衡量的运动能力，全肺切除组从预测值的78%（25%）降至58%（28%），肺叶切除组从77%（21%）降至67%（20%）。FEV1变化与Wmax变化之间仅存在微弱关系（r = 0.54，r2 = 0.30）。全肺切除术后，呼吸困难强度与工作量或呼吸困难强度与通气量之间的关系斜率显著增加，但肺叶切除术后未增加。全肺切除术和肺叶切除术后，腿部不适与工作量相关时增加更快。切除术后，呼吸困难很少是最大运动时的唯一限制因素。研究得出结论：（1）FEV1变化对肺切除术后运动能力变化的预测性较差；（2）全肺切除术导致Wmax降低25%，运动时呼吸困难明显增加；（3）肺叶切除术对Wmax或术后呼吸困难强度几乎没有影响；（4）全肺切除术和肺叶切除术后，腿部不适对运动受限起重要作用。
