Risom Emilie C, Buggeskov Katrine B, Petersen René H, Mortensen Jann, Ravn Hanne B
Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2021 Oct;65(9):1221-1228. doi: 10.1111/aas.13935. Epub 2021 Jun 23.
Impaired lung function is a well-known risk factor in cardiac surgery patients and reduced forced expiratory volume in 1 second (FEV ) is associated with increased mortality. However, there is limited knowledge regarding the influence of impaired diffusing capacity of the lungs for carbon monoxide (DLCO) in unselected cardiac surgery patients. The aim of this study was to investigate the association of impaired DLCO and/or reduced FEV on post-operative mortality and morbidity in cardiac surgery patients.
In a prospective cohort study, 390 patients scheduled for elective cardiac surgery underwent preoperative lung function test including spirometry and DLCO measurements. We defined reduced FEV as FEV below lower limit of normal (LLN) and impaired DLCO as DLCO <60% of predicted.
Mortality within 1 year (90-570 days) was significantly higher in patients with impaired DLCO (12% vs 3%, P = .010) and with reduced FEV (9% vs 3%, P = .028). Mortality was higher in patients with impaired DLCO both in the presence and absence of FEV < LLN. In multivariate analysis, only impaired DLCO [OR: 3.3, 95% confidence interval (CI) 1.4-7.5; P = .005] and age (OR: 1.1 per year, 95% CI 1.0-1.2; P = .001) were independent predictors of the combined outcome of mortality and prolonged intensive care unit (ICU) stay. Impaired DLCO was also associated with post-operative respiratory complications.
In patients undergoing elective cardiac surgery, preoperative impaired FEV and DLCO were associated with increased mortality and morbidity. In multivariate analysis, only DLCO and age were independent predictors of a combined outcome of mortality and prolonged ICU stay.
肺功能受损是心脏手术患者中一个众所周知的危险因素，一秒用力呼气量（FEV₁）降低与死亡率增加相关。然而，对于未经过筛选的心脏手术患者，关于肺一氧化碳弥散量（DLCO）受损的影响，人们了解有限。本研究的目的是调查DLCO受损和/或FEV₁降低与心脏手术患者术后死亡率和发病率之间的关联。
在一项前瞻性队列研究中，390例计划接受择期心脏手术的患者接受了术前肺功能测试，包括肺量计检查和DLCO测量。我们将FEV₁降低定义为FEV₁低于正常下限（LLN），将DLCO受损定义为DLCO<预测值的60%。
DLCO受损的患者（12%对3%，P = 0.010）和FEV₁降低的患者（9%对3%，P = 0.028）1年内（90 - 570天）的死亡率显著更高。无论FEV₁<LLN与否，DLCO受损的患者死亡率均更高。在多变量分析中，只有DLCO受损[比值比（OR）：3.3，95%置信区间（CI）1.4 - 7.5；P = 0.005]和年龄（OR：每年1.1，95%CI 1.0 - 1.2；P = 0.001）是死亡率和延长重症监护病房（ICU）住院时间这一联合结局的独立预测因素。DLCO受损还与术后呼吸并发症相关。
在接受择期心脏手术的患者中，术前FEV₁和DLCO受损与死亡率和发病率增加相关。在多变量分析中，只有DLCO和年龄是死亡率和延长ICU住院时间这一联合结局的独立预测因素。
