Naoum Christopher, Kritharides Leonard, Ing Alvin, Falk Gregory L, Yiannikas John
Department of Cardiology, Concord Repatriation General Hospital, The University of Sydney, Sydney, New South Wales, Australia.
Department of Respiratory Medicine, Concord Repatriation General Hospital, The University of Sydney, Sydney, New South Wales, Australia.
Clin Respir J. 2017 Mar;11(2):139-150. doi: 10.1111/crj.12314. Epub 2015 May 22.
Studies assessing hiatal hernia (HH)-related effects on lung volumes derived by body plethysmography are limited. We aimed to evaluate the effect of hernia size on lung volumes (including assessment by body plethysmography) and the relationship to functional capacity, as well as the impact of corrective surgery.
Seventy-three patients (70 ± 10 years; 54 female) with large HH [mean ± standard deviation, intra-thoracic stomach (ITS) (%): 63 ± 20%; type III in 65/73] had respiratory function data (spirometry, 73/73; body plethysmography, 64/73; diffusing capacity, 71/73) and underwent HH surgery. Respiratory function was analysed in relation to hernia size (groups I, II and III: ≤50, 50%-75% and ≥75% ITS, respectively) and functional capacity. Post-operative changes were quantified in a subgroup.
Total lung capacity (TLC) and vital capacity (VC) correlated inversely with hernia size (TLC: 97 ± 11%, 96 ± 13%, 88 ± 10% predicted in groups I, II and III, respectively, P = 0.01; VC: 110 ± 17%, 111 ± 14%, 98 ± 14% predicted, P = 0.02); however, mean values were normal and only 14% had abnormal lung volumes. Surgery increased TLC (93 ± 11% vs 97 ± 10% predicted) and VC (105 ± 15% vs 116 ± 18%), and decreased residual volume/total lung capacity (RV/TLC) ratio (39 ± 7% vs 37 ± 6%) (P < 0.01 for all). Respiratory changes were modest relative to the marked functional class improvement. Among parameters that improved following HH surgery, decreased TLC and forced expiratory volume in 1 s and increased RV/TLC ratio correlated with poorer functional class pre-operatively.
Increasing HH size correlates with reduced TLC and VC. Surgery improves lung volumes and gas trapping; however, the changes are mild and within the normal range.
评估食管裂孔疝（HH）对通过体容积描记法得出的肺容积影响的研究有限。我们旨在评估疝大小对肺容积的影响（包括通过体容积描记法进行评估）及其与功能能力的关系，以及矫正手术的影响。
73例患有大型HH的患者（70±10岁；54例女性）[平均±标准差，胸腔内胃（ITS）（%）：63±20%；65/73例为III型]有呼吸功能数据（肺量计检查，73/73；体容积描记法，64/73；弥散功能，71/73）并接受了HH手术。分析了呼吸功能与疝大小（I、II和III组：ITS分别≤50%、50%-75%和≥75%）及功能能力的关系。对一个亚组的术后变化进行了量化。
肺总量（TLC）和肺活量（VC）与疝大小呈负相关（TLC：I、II和III组预测值分别为97±11%、96±13%、88±10%，P = 0.01；VC：预测值分别为110±17%、111±14%、98±14%，P = 0.02）；然而，平均值正常，只有14%的患者肺容积异常。手术使TLC增加（预测值从93±11%增加到97±10%）和VC增加（从105±15%增加到116±18%），并降低了残气量/肺总量（RV/TLC）比值（从39±7%降至37±6%）（所有P < 0.01）。相对于显著的功能分级改善，呼吸变化较小。在HH手术后改善的参数中，TLC降低、1秒用力呼气量降低以及RV/TLC比值增加与术前较差的功能分级相关。
HH大小增加与TLC和VC降低相关。手术可改善肺容积和气体潴留；然而，变化轻微且在正常范围内。
