Lawrence V A, Page C P, Harris G D
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7879.
Arch Intern Med. 1989 Feb;149(2):280-5.
Preoperative spirometry is commonly ordered before abdominal surgery, with the goal of predicting and preventing postoperative pulmonary complications. We assessed the evidence for this practice with a systematic literature search and critical appraisal of published studies. The search identified 135 clinical articles, of which 22 (16%) were actual investigations of the use and predictive value of preoperative spirometry. All 22 studies had important methodological flaws that preclude valid conclusions about the value of screening preoperative spirometry. The available evidence indicates that spirometry's predictive value is unproved. Unanswered questions involve (1) the yield of spirometry, in addition to history and physical examination, in patients with clinically apparent lung disease; (2) spirometry's yield in detecting surgically important occult disease; and (3) its utility, or beneficial effect on patient outcome. Spirometry's full potential for risk assessment in the individual patient has not yet been realized.
术前肺活量测定通常在腹部手术前进行，目的是预测和预防术后肺部并发症。我们通过系统的文献检索和对已发表研究的批判性评价来评估这种做法的证据。检索确定了135篇临床文章，其中22篇（16%）是对术前肺活量测定的使用和预测价值的实际研究。所有22项研究都存在重要的方法学缺陷，无法就术前肺活量测定筛查的价值得出有效结论。现有证据表明肺活量测定的预测价值未经证实。未解决的问题包括：（1）除病史和体格检查外，肺活量测定在有明显肺部疾病的患者中的检出率；（2）肺活量测定在检测具有手术重要性的隐匿性疾病中的检出率；以及（3）其效用或对患者预后的有益影响。肺活量测定在个体患者风险评估中的全部潜力尚未实现。
