Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Chest Surgery, Istanbul University, Istanbul, Turkey.
Lung. 2018 Apr;196(2):255-262. doi: 10.1007/s00408-018-0085-y. Epub 2018 Jan 18.
Peak oxygen consumption is a very valuable cardiopulmonary functional parameter in pre-operative evaluation of patients with lung cancer. However, it has several critical limitations for operability decision due to failure in achieving maximal level of exercise test for cases. The aim of this study was to reveal the importance of more accurate cardiopulmonary parameters that can be calculated from data of submaximal level test, such as oxygen uptake efficiency slope (OUES) and to determine whether it could be used in the operability decision phase for borderline cases by means of morbidity and mortality.
One hundred and twenty-five patients who were scheduled to undergo lung surgery due to lung cancer were included in the study. Peak oxygen uptake (pVO), heart rate at the anaerobic threshold, and oxygen consumption volume at anaerobic threshold values were obtained after performing the cardiopulmonary exercise test. The OUES value was calculated from the ratio of the peak VO value and logarithmic equivalent of the ventilatory volume (VE). The following equation was used for determining OUES: VO/log VE.
The peak VO mean value was 21.37 ± 4.20 mL/min/kg in patients. However, OUES mean value was 12.44 ± 2.11. When the metabolic parameters of the patients were compared, a significant correlation was determined between the peak VO value and peak VE, OUES, and survival (p < 0.01).
This study demonstrated that OUES is significantly correlated with peak VO and it does not require the performance of maximal exercise and can be used together with peak VO in this patient population when there is difficulty in making decision for surgery in patients with lung cancer.
最大摄氧量是肺癌患者术前评估心肺功能的一项非常有价值的指标。但由于部分病例无法达到运动试验的最大水平,其对手术可操作性的判断具有一定局限性。本研究旨在揭示可以从次最大运动试验数据中计算得出的更准确的心肺参数的重要性,如摄氧量效率斜率(OUES),并通过发病率和死亡率来确定其是否可以用于边界病例的手术可操作性判断阶段。
本研究共纳入 125 例因肺癌行肺切除术的患者。在进行心肺运动试验后,获得最大摄氧量(pVO)、无氧阈时的心率和无氧阈时的耗氧量。OUES 值通过峰值 VO 值与通气量(VE)对数等效值的比值计算得出。计算公式为:VO/log VE。
患者的平均峰值 VO 值为 21.37±4.20 mL/min/kg,而 OUES 的平均值为 12.44±2.11。当比较患者的代谢参数时,发现峰值 VO 值与峰值 VE、OUES 和生存之间存在显著相关性(p<0.01)。
本研究表明,OUES 与峰值 VO 显著相关,且不需要进行最大运动,在肺癌患者手术决策困难时,可与峰值 VO 一起用于该患者人群。