Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
Anaesthesia. 2017 Oct;72(10):1206-1216. doi: 10.1111/anae.14003. Epub 2017 Jul 25.
This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg .min , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg .min , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes.
本研究旨在探讨摄氧量效率斜率作为老年拟行大型结直肠手术患者心肺功能的客观和亚极量指标的有效性。 年龄≥60 岁、退伍军人活动问卷代谢当量评分≤7、拟行大型结直肠手术的患者参加了术前心肺运动试验。 使用 100%、90%和 80%的运动数据计算摄氧量效率斜率至不同运动强度。 对 71 例患者（47 例男性，平均（标准差）年龄 75.2（6.7）岁）的数据进行了分析。 从所有数据中获得的效率斜率与使用 90%（p = 0.027）和 80%（p = 0.023）数据时的斜率值有统计学差异。 90%和 80%的值彼此之间没有显著差异（p = 0.152）。 摄氧量效率斜率与峰值摄氧量之间的相关性范围为 0.816 至 0.825（均 p<0.001），摄氧量效率斜率与通气无氧阈之间的相关性范围为 0.793 至 0.805（均 p<0.001）。 受试者工作特征曲线显示，摄氧量效率斜率是预测峰值摄氧量≤18.2ml.kg.min 的敏感且特异的指标，曲线下面积（95%置信区间）为 0.876（0.780-0.972，p<0.001），通气无氧阈≤11.1ml.kg.min 的曲线下面积（95%置信区间）为 0.828（0.726-0.929，p<0.001）。 这些相关性表明，摄氧量效率斜率为这些患者提供了心肺功能的有效（亚）最大测量值，所描述的预测能力表明，它可能有助于区分术后发病率较高的患者。 然而，未来的研究应调查摄氧量效率斜率对术后结果的预后价值。
