Towe Christopher W, Wu Katherine, Khil Alina, Perry Yaron, Worrell Stephanie G, Ho Vanessa P, Linden Philip A
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Division of Trauma, Critical Care, Burns, and Emergency General Surgery, MetroHealth Medical Center, Case Western Reserve School of Medicine, Cleveland, OH 44109, USA.
Healthcare (Basel). 2019 Jan 23;7(1):16. doi: 10.3390/healthcare7010016.
Pulmonary function testing (PFT) is commonly used to risk-stratify patients prior to lung resection. Guidelines recommend that patients with reduced lung function, due to chronic lung conditions such as Chronic Obstructive Pulmonary Disease (COPD), should receive additional physiologic testing to determine fitness for resection. We reviewed our experience with six-minute walk testing (SMWT) to determine the association of test results and post-operative complications.
Consecutive adult patients undergoing segmentectomy, lobectomy, bilobectomy or pneumonectomy between 1 January, 2007 and 1 January, 2017 were identified in a prospectively maintained database. Patients with poor lung function, as defined by percent predicted forced expiratory volume in 1 s (FEV1) or diffusion capacity of carbon monoxide (DLCO) ≤60%, had results of SMWT extracted from their chart. Association of test result to post-operative events was performed.
581 patients had anatomic lung resections with predicted post-operative FEV1 or DLCO values ≤60%, consistent with a diagnosis of COPD. Among them, 50 (8.6%) had preoperative SMWT performed. Patients who received SMWT were more likely to have a FEV1 or DLCO less than 40 percent predicted (24/50 (48.0%) vs 166/531 (31.3%), = 0.016). Post-operatively, patients who had SMWT performed had higher rates of pneumonia, but similar rates of major morbidity. The post-exercise oxygen saturation and the amount of desaturation correlated with the occurrence of major morbidity. In multivariable regression, oxygen desaturation was an independent risk factor for the occurrence of major morbidity, and desaturation was an excellent predictor of major morbidity by receiver operating characteristic curves analsysis.
Among patients with elevated risk, oxygen desaturation during SMWT was independently associated with the occurence of major morbidity in multivariable analysis, while pulmonary function testing was not. SMWT is an important tool for risk-stratification, and may be underutilized.
肺功能测试（PFT）常用于肺切除术前对患者进行风险分层。指南建议，因慢性肺部疾病如慢性阻塞性肺疾病（COPD）导致肺功能降低的患者，应接受额外的生理测试以确定是否适合手术切除。我们回顾了我们在六分钟步行测试（SMWT）方面的经验，以确定测试结果与术后并发症之间的关联。
在一个前瞻性维护的数据库中识别出2007年1月1日至2017年1月1日期间接受肺段切除术、肺叶切除术、双肺叶切除术或全肺切除术的连续成年患者。肺功能差的患者，定义为预测1秒用力呼气量（FEV1）或一氧化碳弥散量（DLCO）≤60%，其SMWT结果从病历中提取。分析测试结果与术后事件之间的关联。
581例患者接受了解剖性肺切除术，预测术后FEV1或DLCO值≤60%，符合COPD诊断。其中，50例（8.6%）进行了术前SMWT。接受SMWT的患者FEV1或DLCO低于预测值40%的可能性更大（24/50（48.0%）对166/531（31.3%），P = 0.016）。术后，进行SMWT的患者肺炎发生率较高，但主要并发症发生率相似。运动后血氧饱和度和血氧饱和度下降程度与主要并发症的发生相关。在多变量回归中，血氧饱和度下降是主要并发症发生的独立危险因素，通过受试者工作特征曲线分析，血氧饱和度下降是主要并发症的良好预测指标。
在高危患者中，多变量分析显示，SMWT期间的血氧饱和度下降与主要并发症的发生独立相关，而肺功能测试则不然。SMWT是风险分层的重要工具，可能未得到充分利用。
