Khurana Harneet S, Kamath Sushmit, Ghosh Kakali, Biswas Arunava, Dasgupta Chaitali Sen
Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Anaesthesia, Goa Medical College, Bambolim, Goa, India.
J Anaesthesiol Clin Pharmacol. 2024 Jul-Sep;40(3):470-477. doi: 10.4103/joacp.joacp_317_23. Epub 2024 Mar 15.
Evaluation of pulmonary function by spirometer in adult patients undergoing cardiac surgery is a simple test to assess pulmonary reserve that has important implications in operative morbidity. However, there is no established consensus regarding which patients should undergo preoperative pulmonary function tests (PFTs), including forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). The primary aim was to evaluate the outcome of preoperative PFTs on patients undergoing rheumatic mitral valve surgery.
One hundred patients undergoing rheumatic mitral valve surgery, meeting the inclusion criteria, were included in this prospective observational study. The pulmonary function of the patients was assessed using a spirometer before surgery. Preoperative pulmonary artery systolic pressure (PASP) and arterial blood gas (ABG) analyses were also performed. The correlation of PFTs with early postsurgical outcome, comprising mortality within 30 days of surgery and morbidity defined as the existence of at least one of the postoperative complications, such as low cardiac output state indicated by increased requirement of inotropes, prolonged ventilation (>24 hours), postoperative new-onset hemodynamically significant arrhythmias, renal dysfunction, and post-op infection, was assessed.
With the increasing New York Heart Association (NYHA) class of the patient, there was a decline of FEV1% and FVC%, which was statistically significant ( < 0.0001). There was a significant positive correlation of FVC% with preoperative saturation of peripheral oxygen (SpO2) and preoperative saturation of peripheral carbon dioxide (PaO2) and FEV1% with preoperative SpO2 and preoperative PaO2. Patients who had postoperative prolonged ventilation had lower values of FVC% and FEV1%, which was statistically significant ( < 0.001). The patients who expired had significantly lower values of FVC% and FEV1%.
Preoperative lung function has an implication on intraoperative morbidity during cardiac surgery although a common consensus on its application is lacking. Preoperative spirometry can be one of the parameters for predicting postoperative morbidity and mortality in patients undergoing rheumatic mitral valve surgery. Spirometry might have a role to play in predicting patient outcomes in rheumatic mitral valve surgeries; however, larger well-powered studies are needed.
对于接受心脏手术的成年患者，通过肺活量计评估肺功能是一项简单的测试，可用于评估肺储备功能，这对手术并发症具有重要意义。然而，对于哪些患者应接受术前肺功能测试（PFTs），包括第一秒用力呼气量（FEV1）和用力肺活量（FVC），目前尚无定论。主要目的是评估术前PFTs对接受风湿性二尖瓣手术患者的影响。
本前瞻性观察研究纳入了100例符合纳入标准且接受风湿性二尖瓣手术的患者。术前使用肺活量计评估患者的肺功能。还进行了术前肺动脉收缩压（PASP）和动脉血气（ABG）分析。评估了PFTs与术后早期结局的相关性，术后早期结局包括手术30天内的死亡率以及定义为存在至少一种术后并发症的发病率，这些并发症如因血管活性药物需求增加表明的心输出量低状态、通气时间延长（>24小时）、术后新发血流动力学显著的心律失常、肾功能不全和术后感染。
随着患者纽约心脏协会（NYHA）分级的增加，FEV1%和FVC%下降，差异具有统计学意义（<0.0001）。FVC%与术前外周血氧饱和度（SpO2）和术前外周血二氧化碳分压（PaO2）呈显著正相关，FEV1%与术前SpO2和术前PaO2呈显著正相关。术后通气时间延长的患者FVC%和FEV1%值较低，差异具有统计学意义（<0.001）。死亡患者的FVC%和FEV1%值显著较低。
尽管术前肺功能对心脏手术术中并发症的影响缺乏普遍共识，但术前肺功能对心脏手术术中并发症有影响。术前肺活量测定可作为预测风湿性二尖瓣手术患者术后并发症和死亡率的参数之一。肺活量测定可能在预测风湿性二尖瓣手术患者结局方面发挥作用；然而，需要更大规模、更有说服力的研究。
