Gomibuchi M, Fujisaki T, Tanaka S, Sasai T, Yamauchi H, Hayashi K, Morota T, Bessyo R, Mikami T, Shoji T
Department of Thoracic and Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Mar;41(3):403-8.
We studied the prediction of postoperative complications in patients whose predicted postoperative FEV1.0% and/or %VC were below fifty. Preoperative exercise tests were performed in 88 cases mainly old patients of age or with impaired pulmonary function; 57 were lobectomies, 10 were bilobectomies and 21 were pneumonectomies. Predicted postoperative FEV1.0% and/or %VC were below fifty in 29 cases consisting of 12 lobectomies, one bilobectomy and 16 pneumonectomies. Among these 29 patients, thirteen suffered postoperative complications (A group) and sixteen did not (B group). All five cases of operative death (death within 30 days after operation) were included in the A group. The prediction of postoperative complications in cases of which pred. postope, FEV1.0% and %VC were fifty or over (C group) was also studied. The results were as follows; (1) The percentage of complications among A and B groups was higher than that among C group but no statistical difference could be found. (2) In the A group, the number of pred. postope. FEV1.0% and/or %VC had little correlation to complications. (3) Statistical differences between A and B group were found in submax VO2 (p < 0.05), VO2/VE at AT (p < 0.001) and VCO2/VE at submaximal exercise (p < 0.001). (4) Cardiac output ratio of maximal exercise to rest had marked correlation to complications (p < 0.001) in C group but had no correlation in the A and B groups. (5) The three items of A and B groups, submax VO2 < 500 ml/min/m2, VO2/VE at AT < 40 ml/l and submax VCO2/VE < 25 ml/l, showed high correlation to operative death (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了术后预测第1秒用力呼气容积(FEV1.0%)和/或肺活量百分比(%VC)低于50%的患者术后并发症的情况。对88例主要为老年或肺功能受损的患者进行了术前运动测试;其中57例行肺叶切除术,10例行双肺叶切除术,21例行全肺切除术。29例患者术后预测FEV1.0%和/或%VC低于50%,包括12例肺叶切除术、1例双肺叶切除术和16例全肺切除术。在这29例患者中,13例出现术后并发症(A组),16例未出现(B组)。所有5例手术死亡(术后30天内死亡)均在A组。还研究了术后预测FEV1.0%和%VC为50%及以上的患者(C组)术后并发症的情况。结果如下:(1)A组和B组的并发症发生率高于C组,但无统计学差异。(2)在A组中,术后预测FEV1.0%和/或%VC的数值与并发症的相关性较小。(3)A组和B组在次极量摄氧量(p<0.05)、无氧阈时的摄氧量/分钟通气量(VO2/VE,p<0.001)和次极量运动时的二氧化碳排出量/分钟通气量(VCO2/VE,p<0.001)方面存在统计学差异。(4)C组中最大运动时的心输出量与静息时的心输出量之比与并发症有显著相关性(p<0.001),而A组和B组则无相关性。(5)A组和B组的三项指标,即次极量摄氧量<500 ml/min/m2、无氧阈时的VO2/VE<40 ml/l和次极量VCO2/VE<25 ml/l,与手术死亡有高度相关性(p<0.001)。(摘要截断于250字)