Shin Beomsu, Lee Hyun, Kang Danbee, Jeong Byeong-Ho, Kang Hyung Koo, Chon Hae Ri, Koh Won-Jung, Chung Man Pyo, Guallar Eliseo, Cho Juhee, Park Hye Yun
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.
Respirology. 2017 Jul;22(5):935-941. doi: 10.1111/resp.12988. Epub 2017 Jan 24.
The association between airflow limitation severity and post-operative pulmonary complications (PPCs) among COPD patients undergoing extra-pulmonary surgery is unknown. We evaluated the association between forced expiratory volume in 1 s (FEV ) and PPC in COPD patients undergoing extra-pulmonary surgery.
Using prospective cohort of PPC evaluation for extra-pulmonary surgery, we identified 694 COPD patients who conducted PPC evaluation before extra-pulmonary surgery between March 2014 and January 2015 at a tertiary hospital, Seoul, Korea.
The overall incidence of PPC was 24.4%. The incidence of PPC in quintiles 1-5 of FEV (% predicted) was 31.4, 25.8, 23.7, 21.6 and 19.7%, respectively (P for trend: 0.019). In fully adjusted multivariable models, the relative risks (RRs, 95% CI) for PPC comparing participants in quintiles 1-4 of FEV (% predicted) with those in quintile 5 were 1.69 (1.03-2.79), 1.41 (0.83-2.37), 1.26 (0.75-2.11) and 1.30 (0.76-2.22), respectively (P for trend: 0.046). The association of severe airflow limitation with respiratory failure and post-operative exacerbations was stronger in participants who did not use bronchodilators compared with those who did.
We found a progressive and significant relationship between severity of airflow limitation and the incidence of PPC in COPD patients undergoing extra-pulmonary surgery. Furthermore, perioperative bronchodilator use was associated with a reduced risk of respiratory failure and post-operative exacerbations in patients with severe airflow limitation.
接受肺外手术的慢性阻塞性肺疾病（COPD）患者中，气流受限严重程度与术后肺部并发症（PPCs）之间的关联尚不清楚。我们评估了接受肺外手术的COPD患者一秒用力呼气容积（FEV₁）与PPC之间的关联。
采用肺外手术PPC评估的前瞻性队列研究，我们纳入了2014年3月至2015年1月在韩国首尔一家三级医院接受肺外手术前进行PPC评估的694例COPD患者。
PPC的总体发生率为24.4%。FEV₁（预测值%）五分位数1 - 5中PPC的发生率分别为31.4%、25.8%、23.7%、21.6%和19.7%（趋势P值：0.019）。在完全调整的多变量模型中，将FEV₁（预测值%）五分位数1 - 4的参与者与五分位数5的参与者相比，PPC的相对风险（RRs，95%CI）分别为1.69（1.03 - 2.79）、1.41（0.83 - 2.37）、1.26（0.75 - 2.11）和1.30（0.76 - 2.22）（趋势P值：0.046）。与使用支气管扩张剂的参与者相比，未使用支气管扩张剂的参与者中严重气流受限与呼吸衰竭和术后病情加重的关联更强。
我们发现接受肺外手术的COPD患者中，气流受限严重程度与PPC发生率之间存在逐渐增强且显著的关系。此外，围手术期使用支气管扩张剂与严重气流受限患者呼吸衰竭和术后病情加重风险降低相关。
