Neunhaeuserer Daniel, Gasperetti Andrea, Savalla Francesco, Gobbo Stefano, Bullo Valentina, Bergamin Marco, Foletto Mirto, Vettor Roberto, Zaccaria Marco, Ermolao Andrea
Department of Medicine, Sports and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Week Surgery, Bariatric Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Obes Surg. 2017 Dec;27(12):3230-3239. doi: 10.1007/s11695-017-2763-x.
Although sleeve gastrectomy (SG) has become an important treatment option in severe obesity, cardiorespiratory and muscle function after SG has not adequately been investigated.
This is an observational study in 26 obese patients (BMI 45.2 ± 5.8 kg/m), comparing physical function before and after 6 months from SG. All available patients listed for SG were here included. Incremental cardiopulmonary exercise tests, standardized strength tests, and balance analysis were performed.
The substantial weight loss (-33.4 ± 11.0 kg) after SG led to increased peak work capacity (metabolic equivalents, METs) and relative peak oxygen uptake (VOpeak/kg) (both p < 0.001). However, the absolute VOpeak, oxygen pulse (VO/heart rate (HR)), and the oxygen uptake efficiency slope (OUES) significantly declined after SG (all p < 0.001). Furthermore, HR/VO-slope significantly worsened after SG (p < 0.001), whereas the HR reserve and HR recovery improved (all p ≤ 0.01). Parameters of ventilatory efficiency were not affected by SG. The time-constant (Tau τ) of the fundamental component of VO-kinetics, reflecting oxygen metabolism in skeletal muscles, was found to be significantly worsened after SG (p < 0.05). Finally, muscle strength and balance parameters were not much affected by SG.
The ventilatory and cardiac function do not appear negatively affected by SG; thus, we hypothesize that the decrease in aerobic capacity could be due to alterations in peripheral muscles. This might in part be due to a loss of muscle mass, although our patients' muscle strength did not decrease. Pilot results from VO-kinetics analysis seem to support the hypothesis of a deterioration of oxidative muscle metabolism after SG.
尽管袖状胃切除术（SG）已成为重度肥胖的重要治疗选择，但SG术后的心肺功能和肌肉功能尚未得到充分研究。
这是一项针对26例肥胖患者（BMI 45.2±5.8kg/m²）的观察性研究，比较SG术后6个月前后的身体功能。所有列入SG手术的可用患者均纳入本研究。进行了递增心肺运动试验、标准化力量测试和平衡分析。
SG术后显著减重（-33.4±11.0kg）导致峰值工作能力（代谢当量，METs）和相对峰值摄氧量（VO₂peak/kg）增加（均p<0.001）。然而，SG术后绝对VO₂peak、氧脉搏（VO₂/心率（HR））和摄氧效率斜率（OUES）显著下降（均p<0.001）。此外，SG术后HR/VO斜率显著恶化（p<0.001），而心率储备和心率恢复改善（均p≤0.01）。通气效率参数不受SG影响。反映骨骼肌氧代谢的VO₂动力学基本成分的时间常数（Tau τ）在SG术后显著恶化（p<0.05）。最后，肌肉力量和平衡参数受SG影响不大。
SG似乎未对通气和心脏功能产生负面影响；因此，我们推测有氧运动能力的下降可能是由于外周肌肉的改变。这可能部分归因于肌肉量的减少，尽管我们的患者肌肉力量并未下降。VO₂动力学分析的初步结果似乎支持SG术后氧化肌肉代谢恶化的假设。
