Vaughan R W, Cork R C, Hollander D
Anesthesiology. 1981 Apr;54(4):325-8. doi: 10.1097/00000542-198104000-00013.
Pulmonary function tests (PFTs) and arterial oxygenation were studied 24 hours preoperatively and again at varying times (5 to 20 months) during the postoperative weight loss of 37 morbidly obese patients. Among PFTs, expiratory reserve volume (ERV) demonstrated the most significant (P less than 0.001) improvement with weight loss. No clinically relevant differences were found after weight loss in FEV1, FVC, or MMEF. In 11 patients whose arterial blood gases were sampled before and after weight loss, a significant correlation was demonstrated between change in ERV and change in Pao2 (r = 0.59, P less than 0.05) and P(A-a)o2 (r = 0.76, P less than 0.01). When weight loss is expressed as either change in body mass index (delta BMI) or as a change in percent of ideal weight (delta wt), there existed a weight loss threshold for improvement in arterial oxygenation. A delta BMI of greater than 20 or a delta wt more than 100 per cent resulted in a significant improvement in Pao2 (P less than 0.01) or P(A-a)o2 (P less than 0.05). These data suggest that morbidly obese patients do not meaningfully improve FEV1, FVC, or MMEF with massive weight loss. However, there is a significant improvement in ERV that directly correlates with improvement in both Pao2, and P(A-a)o2.
对37例病态肥胖患者术前24小时及术后不同时间（5至20个月）体重减轻期间的肺功能测试（PFTs）和动脉氧合情况进行了研究。在PFTs中，呼气储备量（ERV）随体重减轻改善最为显著（P<0.001）。体重减轻后，第一秒用力呼气容积（FEV1）、用力肺活量（FVC）或最大呼气中期流速（MMEF）未发现临床相关差异。在11例体重减轻前后采集动脉血气的患者中，ERV变化与动脉血氧分压（Pao2）变化（r = 0.59，P<0.05）及肺泡-动脉氧分压差（P(A-a)o2）变化（r = 0.76，P<0.01）之间存在显著相关性。当体重减轻以体重指数变化（delta BMI）或理想体重百分比变化（delta wt）表示时，动脉氧合改善存在体重减轻阈值。delta BMI大于20或delta wt超过100%会导致Pao2（P<0.01）或P(A-a)o2（P<0.05）显著改善。这些数据表明，病态肥胖患者大量减重后，FEV1、FVC或MMEF无明显改善。然而，ERV有显著改善，且与Pao2和P(A-a)o2的改善直接相关。
