Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
Respiration. 2019;98(6):521-526. doi: 10.1159/000502310. Epub 2019 Sep 3.
Adequate target lobe selection for endobronchial valve (EBV) treatment in patients with severe emphysema is essential for treatment success and can be based on emphysema destruction, lobar perfusion, lobar volume, and collateral ventilation. As some patients have >1 target lobe for EBV treatment, we were interested whether we could identify the least functional lobe.
The objective of this study was to investigate the relationship between endoscopic lobar measurement of oxygen uptake, lobar destruction, and vascular volume, and whether this could help in identifying the least functional lobe and thus optimal target for EBV treatment.
We prospectively included patients who were scheduled for EBV treatment in our hospital. A customized gas analysis setup was used to measure lobar O2 uptake after lobar balloon occlusion. Quantitative CT analysis was performed to assess the degree of emphysematous destruction and lobar arterial and venous volumes.
Twenty-one (5 male/16 female) patients with emphysema (median age 63 years, FEV1 25% of predicted, residual volume 234% of predicted) were included, and 49 endoscopic lobar measurements were performed. A lower O2 uptake significantly correlated with a higher degree of emphysematous lobar destruction (Spearman's ρ: 0.39, p < 0.01), and lower arterial and venous vascular volumes of the lobes (-0.46 and -0.47, respectively; both p < 0.001).
Endoscopic measurement of lobar O2 uptake is feasible in patients with emphysema. Measurement of lobar O2 uptake helped to identify the least functional lobe and can be used as additional tool for EBV target lobe selection.
在严重肺气肿患者中，为支气管内瓣膜（EBV）治疗选择足够的靶肺叶对于治疗成功至关重要，可基于肺气肿破坏、肺叶灌注、肺叶体积和侧支通气进行选择。由于一些患者有>1 个用于 EBV 治疗的靶肺叶，我们想知道是否可以识别出功能最差的肺叶。
本研究旨在探讨内镜下测量肺叶摄氧量、肺叶破坏和血管容积之间的关系，以及这是否有助于识别功能最差的肺叶，从而为 EBV 治疗选择最佳靶肺叶。
我们前瞻性纳入了在我院接受 EBV 治疗的患者。使用定制的气体分析装置在肺叶球囊闭塞后测量肺叶氧摄取。进行定量 CT 分析以评估肺气肿破坏的程度以及肺叶动脉和静脉容积。
共纳入 21 例（5 例男性/16 例女性）肺气肿患者（中位年龄 63 岁，FEV1 预测值的 25%，残气量预测值的 234%），共进行了 49 次内镜肺叶测量。较低的 O2 摄取与较高的肺气肿肺叶破坏程度显著相关（Spearman's ρ：0.39，p < 0.01），且肺叶的动脉和静脉血管容积也较低（分别为-0.46 和-0.47，均 p < 0.001）。
在肺气肿患者中，内镜测量肺叶 O2 摄取是可行的。肺叶 O2 摄取的测量有助于识别功能最差的肺叶，并可作为 EBV 靶肺叶选择的附加工具。
