Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Br J Anaesth. 2017 Dec 1;119(suppl_1):i34-i43. doi: 10.1093/bja/aex393.
There is a consistent relationship between physical activity, physical fitness, and health across almost all clinical contexts, including the perioperative setting. Physiological measurements obtained during physical exercise may be used to infer the risk of adverse outcome after major surgery. In particular, data obtained from perioperative cardiopulmonary exercise testing have an expanding role in perioperative care. Such information may be used to inform a variety of changes in clinical practice, including interventions that may reduce the risk of perioperative adverse events. Specifically, for patients undergoing major cancer surgery there is a complex interplay between different cancer treatments, including neoadjuvant therapies (chemo- and chemo- plus radiotherapy), surgery, and physical fitness, and the modulation of these relationships by perioperative exercise interventions. Preoperative cardiopulmonary exercise testing provides an objective evaluation of physical fitness and has been used to provide an individualized risk profile in order to guide collaborative decision-making, inform the consent process, characterize and optimize co-morbidities, and to triage patients to perioperative care. Furthermore, studies evaluating exercise interventions aimed at increasing preoperative exercise capacity have established that training improves physical fitness. However, to date, this literature is largely composed of feasibility and pilot studies with small sample sizes, which are in general underpowered to assess clinical outcomes. Adequately powered prospective multicentre studies are needed to characterize the most effective means of improving patient fitness before surgery and to evaluate the impact of such improvements on surgical and disease-specific (e.g. cancer) outcomes.
在几乎所有临床环境中，包括围手术期，体力活动、身体状况和健康之间存在一致的关系。在体力活动期间获得的生理测量值可用于推断重大手术后不良结果的风险。特别是，围手术期心肺运动测试获得的数据在围手术期护理中具有扩展作用。这些信息可用于告知临床实践的各种变化，包括可能降低围手术期不良事件风险的干预措施。具体来说，对于接受重大癌症手术的患者，不同的癌症治疗方法（包括新辅助疗法[化疗和化疗加放疗]、手术和身体状况）之间存在复杂的相互作用，并且围手术期运动干预可调节这些关系。术前心肺运动测试提供了身体状况的客观评估，并已用于提供个性化的风险概况，以指导协作决策、告知同意过程、特征化和优化合并症，并将患者分诊到围手术期护理。此外，评估旨在增加术前运动能力的运动干预措施的研究表明，训练可提高身体状况。然而，迄今为止，该文献主要由可行性和试点研究组成，这些研究样本量较小，通常不足以评估临床结局。需要进行足够的、前瞻性的、多中心研究，以确定在手术前提高患者健康状况的最有效方法，并评估此类改善对手术和疾病特异性（例如癌症）结局的影响。
