Cordova F, O'Brien G, Furukawa S, Kuzma A M, Travaline J, Criner G J
Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
Chest. 1997 Oct;112(4):907-15. doi: 10.1378/chest.112.4.907.
To evaluate the long-term stability of improvements in exercise capacity and quality of life (QOL) after lung volume reduction surgery (LVRS).
Case-series analysis.
University hospital.
Twenty-six patients with severe airflow obstruction (mean FEV1 of 0.67+/-0.18 L) and moderate to severe hyperinflation (mean total lung capacity of 7.30+/-1.90 L).
All patients underwent bilateral LVRS via median sternotomy. Serial measurement of lung function, symptom-limited cardiopulmonary exercise tests, 6-min walk distances (6MWD), and sickness impact profile (SIP) scores were done before, and at 3, 6, 12, and 18 months after surgery.
FEV1 (0.93+/-0.29 vs 0.68+/-0.19 L, p<0.001) increased while residual volume (3.47+/-1.2 vs 4.77+/-1.5 L, p<0.001) decreased significantly at 3 months post-LVRS compared to baseline, and these changes were maintained at 12 to 18 months follow-up. Similarly, the increase in 6MWD at 3 months post-LVRS (340+/-84 vs 251+/-114 m, p<0.001) was sustained at all follow-up times. On cardiopulmonary exercise testing, total exercise time (9.0+/-1.8 vs 6.1+/-1.9 min, p<0.001), oxygen uptake at peak exercise (VO2 peak) (14.9+/-4 vs 11.9+/-3 mL/kg/min, p<0.001), maximum oxygen pulse (7.43+/-2.37 vs 5.85+/-1.96 mL/beat, p<0.005), and maximum minute ventilation (VEmax) (30.3+/-10 vs 23.5+/-7.1 L/min, p<0.001) increased significantly at 3 months post-LVRS. On serial study following LVRS, total exercise time remained significantly greater at 6 (8.5+/-1.38 min) and 12 months (8.71+/-2.0 min) post-LVRS compared to baseline (5.81+/-1.9 min, p<0.05). VO2 peak tended to be higher at all follow-up periods (3 months, 16.1+/-4.3; 6 months, 14.5+/-2.6; 12 months, 14.1+/-3.5 mL/kg) compared to baseline (12.6+/-3.9 mL/kg, p=0.08). Similarly, maximum O2 pulse tended to be higher in all follow-up studies (3 months, 8.45+/-2.7; 6 months, 7.6+/-1.7; 12 months, 7.42+/-2.1 mL/beat) compared to baseline (6.39+/-2.5 mL/beat, p=0.06). Higher VEmax continued to be observed at 6 (30+/-10 L/min) and 12 months (28+/-10 L/min) post-LVRS, compared to baseline (23+/-7 L/min, p=0.02). VEmax post-LVRS was significantly higher at 3 and 6 months compared to baseline on post-hoc analysis (p<0.05). Overall SIP scores were lower at 3 months (7 vs 18, p<0.0002) post-LVRS and were sustained in long-term follow-up.
We conclude that bilateral LVRS via median sternotomy in selected patients with severe, diffuse emphysema improves exercise performance and QOL at 3 months following LVRS and these improvements are maintained for at least 12 to 18 months in follow-up.
评估肺减容手术（LVRS）后运动能力和生活质量（QOL）改善的长期稳定性。
病例系列分析。
大学医院。
26例严重气流阻塞患者（平均第一秒用力呼气容积[FEV1]为0.67±0.18L）和中度至重度肺过度充气患者（平均肺总量为7.30±1.90L）。
所有患者均通过正中胸骨切开术接受双侧LVRS。在手术前以及术后3、6、12和18个月进行肺功能、症状限制心肺运动试验、6分钟步行距离（6MWD）和疾病影响概况（SIP）评分的系列测量。
与基线相比，LVRS术后3个月时FEV1显著增加（0.93±0.29 vs 0.68±0.19L，p<0.001），而残气量显著减少（3.47±1.2 vs 4.77±1.5L），p<0.001，并且这些变化在12至18个月的随访中得以维持。同样地，LVRS术后3个月时6MWD的增加（340±84 vs 251±114m，p<0.001）在所有随访时间均持续存在。在心肺运动试验中，LVRS术后3个月时总运动时间（9.0±1.8 vs 6.1±1.9分钟，p<0.001）、运动峰值摄氧量（VO2峰值）（14.9±4 vs 11.9±3mL/kg/分钟，p<0.001）、最大氧脉搏（7.43±2.37 vs 5.85±1.96mL/次搏动，p<0.005）以及最大分钟通气量（VEmax）（30.3±10 vs 23.5±7.1L/分钟，p<0.001）均显著增加。在LVRS后的系列研究中，与基线（5.81±1.9分钟，p<0.05）相比，LVRS术后6个月（8.5±1.38分钟）和12个月（8.71±2.0分钟）时总运动时间仍显著更长。在所有随访期，VO2峰值均倾向于高于基线（3个月时为16.1±4.3；6个月时为14.5±2.6；12个月时为14.1±3.5mL/kg）（基线为12.6±3.9mL/kg，p=0.08）。同样地，在所有随访研究中，最大氧脉搏均倾向于高于基线（3个月时为8.45±2.7；6个月时为7.6±1.7；12个月时为7.42±2.1mL/次搏动）（基线为6.39±2.5mL/次搏动，p=0.06）。与基线（23±7L/分钟，p=0.02）相比，LVRS术后6个月（30±10L/分钟）和12个月（28±10L/分钟）时仍观察到较高的VEmax。事后分析显示，LVRS术后3个月和6个月时VEmax显著高于基线（p<0.05）。总体SIP评分在LVRS术后3个月时较低（7 vs 18，p<0.0002），并在长期随访中得以维持。
我们得出结论，对于选定的重度弥漫性肺气肿患者，通过正中胸骨切开术进行双侧LVRS可在LVRS术后3个月改善运动能力和生活质量，并且这些改善在随访中至少维持12至18个月。
