Pate P, Tenholder M F, Griffin J P, Eastridge C E, Weiman D S
Department of Medicine, University of Tennessee, Memphis 38163, USA.
Ann Thorac Surg. 1996 May;61(5):1494-500. doi: 10.1016/0003-4975(96)00087-2.
We wanted to determine if cardiopulmonary exercise testing could better identify the threshold where physiologic function is irreparably impaired for patients with borderline pulmonary function who are being considered for lung cancer resection.
We performed an open, prospective preoperative trial and a postoperative outcome evaluation with a combined medical, surgical, and exercise physiology evaluation at three university hospitals. All eligible patients had spirometry, lung volume determination, and quantitative perfusion scanning and performed a cardiopulmonary stress test, stair climbing, and a 12-minute walk for distance. Functional status was determined with an Eastern Cooperative Oncology Group score, a dyspnea score, and a cardiopulmonary risk index.
We identified 12 patients who met strict criteria for borderline pulmonary function during a 1-year study period. The mean forced expiratory volume in 1 second (FEV1) was 1.38 L (48% of predicted). The mean predicted postoperative FEV1 based on pneumonectomy was 700 mL. Eleven of the patients did the stair climb and 10 passed. All 12 patients achieved a maximum oxygen consumption greater than or equal to 10 mL x kg(-1) x min(-1) (mean value, 13.8 mL x kg(-1) x min(-1)). Thirteen operations were performed on the 12 patients. Nine complications occurred in 7 patients.
Patients with borderline pulmonary function can undergo resection safely if they have an FEV1 equal to or greater than 1.6 L or 40% of its predicted value, a predicted postoperative FEV1 of 700 mL or more, a maximum oxygen consumption of 10 mL x kg(-1) x min(-1) or greater, or stair climbing of three flights or more. Cardiopulmonary stress testing and stair climbing add valuable clinical information for patients with an FEV1 of less than 1.6 L.
我们想要确定心肺运动试验是否能更好地识别对于正在考虑接受肺癌切除术的临界肺功能患者而言，生理功能出现不可逆转损害的阈值。
我们在三家大学医院进行了一项开放性、前瞻性术前试验以及术后结局评估，综合了医学、外科和运动生理学评估。所有符合条件的患者均进行了肺活量测定、肺容积测定和定量灌注扫描，并进行了心肺应激试验、爬楼梯试验和12分钟步行距离试验。通过东部肿瘤协作组评分、呼吸困难评分和心肺风险指数来确定功能状态。
在为期1年的研究期间，我们确定了12例符合临界肺功能严格标准的患者。1秒用力呼气量（FEV1）的平均值为1.38升（占预测值的48%）。基于肺切除术的术后FEV1预测平均值为700毫升。11例患者进行了爬楼梯试验，10例通过。所有12例患者的最大耗氧量均大于或等于10毫升×千克⁻¹×分钟⁻¹（平均值为13.8毫升×千克⁻¹×分钟⁻¹）。对这12例患者进行了13台手术。7例患者出现了9例并发症。
临界肺功能患者如果FEV1等于或大于1.6升或其预测值的40%，术后FEV1预测值为700毫升或更高，最大耗氧量为10毫升×千克⁻¹×分钟⁻¹或更高，或者能爬上三层或更多楼层的楼梯，则可以安全地接受切除术。心肺应激试验和爬楼梯试验为FEV1小于1.6升的患者提供了有价值的临床信息。
