患有过度中央气道塌陷患者的术前检查：支架评估是否起作用？
Preoperative Workup of Patients With Excessive Central Airway Collapse: Does Stent Evaluation Serve a Role?
机构信息
Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
出版信息
J Bronchology Interv Pulmonol. 2024 Apr 1;31(2):146-154. doi: 10.1097/LBR.0000000000000935.
BACKGROUND
Tracheobronchoplasty (TBP) is a definitive anatomic intervention for patients with severe symptomatic expiratory central airway collapse. Although stent evaluations have been described for surgical workup, current literature does not address if improvement during stent evaluation is sustained after TBP. We compared health-related quality of life (HRQOL) and functional status responses after airway stenting to those post-TBP.
METHODS
A retrospective review was performed in patients with severe expiratory central airway collapse who underwent stent evaluation followed by TBP from January 2004 to December 2019. Baseline, poststent, 3- and 12-month postoperative HRQOL scores, and functional status were analyzed with statistical tests as appropriate.
RESULTS
One hundred twenty patients underwent a stent evaluation and TBP. Baseline and stent evaluation measurements were compared with statistically and clinically significant differences in the Cough Quality-of-life Questionnaire (CQLQ) (55 vs. 68, P <0.01), Modified Medical Research Council (mMRC) 0 to 2 (90% vs. 47%, P <0.01), 6-minute walk test (6MWT) (1301 ft vs. 1138 ft, P <0.01). Improvements in the HRQOL and functional status were maintained from stent evaluation to 3 months postoperatively [CQLQ 55 vs. 54, P =0.63; mMRC 0 to 2 (87% vs. 84%), P =0.39; 6MWT 1350 ft vs. 1314 ft, P =0.33], and 12 months postoperatively [CQLQ 54 vs. 54, P =0.91; mMRC 0 to 2 (95% vs. 86%), P =0.74; 6MWT 1409 ft vs. 1328 ft, P =0.13]. The magnitude of change between the data was not significantly different between the stent evaluation, 3-, and 12 months postoperative. Predicted forced expiratory volume in 1-second measurements at baseline, after stent placement, 3 months, and 12 months post-TBP were 74%, 79%, 73%, and 73%, respectively, and not clinically significant.
CONCLUSIONS
Improvement after stent evaluation and the magnitude of improvement may be predictive of postoperative outcomes up to 1 year after surgery.
背景
气管支气管成形术（TBP）是一种用于治疗严重症状性呼气性中央气道塌陷患者的确定性解剖干预措施。虽然已经描述了支架评估用于手术准备，但目前的文献并未探讨 TBP 后支架评估期间的改善是否持续。我们比较了气道支架置入后的健康相关生活质量（HRQOL）和功能状态反应与 TBP 后的反应。
方法
对 2004 年 1 月至 2019 年 12 月期间接受支架评估和 TBP 的严重呼气性中央气道塌陷患者进行回顾性研究。使用适当的统计检验分析了基线、支架后、3 个月和 12 个月术后 HRQOL 评分和功能状态。
结果
120 例患者接受了支架评估和 TBP。在 Cough Quality-of-life Questionnaire（CQLQ）（55 与 68，P<0.01）、改良的医学研究委员会（mMRC）0 至 2（90%与 47%，P<0.01）和 6 分钟步行试验（6MWT）（1301 英尺与 1138 英尺，P<0.01）方面，基线和支架评估测量值存在具有统计学和临床意义的差异。从支架评估到术后 3 个月，HRQOL 和功能状态的改善得到维持[CQLQ 55 与 54，P=0.63；mMRC 0 至 2（87%与 84%），P=0.39；6MWT 1350 英尺与 1314 英尺，P=0.33]，术后 12 个月时仍能维持[CQLQ 54 与 54，P=0.91；mMRC 0 至 2（95%与 86%），P=0.74；6MWT 1409 英尺与 1328 英尺，P=0.13]。支架评估、术后 3 个月和 12 个月之间的数据变化幅度之间没有显著差异。TBP 后基线、支架放置后、3 个月和 12 个月的预测 1 秒用力呼气量分别为 74%、79%、73%和 73%，均无临床意义。
结论
支架评估后的改善以及改善的幅度可能可以预测术后 1 年的手术结果。
Zotero 插件