Brenner M, McKenna R J, Gelb A F, Fischel R J, Yoong B, Huh J, Osann K, Chen J C
Division of Pulmonary Medicine, UC Irvine Medical Center, Orange, Calif 92668, USA.
Chest. 1997 Oct;112(4):916-23. doi: 10.1378/chest.112.4.916.
Lung volume reduction surgery (LVRS) has shown promise for treating patients with severe emphysema in recent clinical trials. However, response following surgery is difficult to assess due to frequent discrepancies between subjective and objective outcomes. We evaluated the relationship between improvement in dyspnea and pulmonary function response in 145 consecutive patients with inhomogeneous emphysema enrolled in a bilateral thoracoscopic lung volume reduction protocol in order to assess predictors of improved dyspnea outcome and correlation of subjective and objective improvement measures.
Baseline complete pulmonary function testing, spirometry, gas exchange, plethysmography, gas dilution lung volumes, along with resting dyspnea index determinations were performed preoperatively, and repeated short term (mean, 33 days; n=129) and long term (>6 months; mean, 276 days; n=84) following surgery.
Improvement in FEV1 percent predicted was significantly associated with improvement in dyspnea scores, though considerable variability exists (r=0.04, p<0.01, short term; r=0.4, p=0.1, long term). In this preselected patient group, those with the extreme degrees of hyperinflation may have less improvement in dyspnea following LVRS than those with milder preoperative hyperinflation. Greater improvement in dyspnea short term and long term was seen in patients with lower presenting residual volume/total lung capacity ratios (r=0.4, p=0.02, short term; r=0.4, p<0.05, long term).
Bilateral thoracoscopic staple LVRS results in significant objective and subjective improvement in patients with severe emphysema and hyperinflation. There was considerable variability between improvement in dyspnea and improvement in spirometry, and preoperative predictors of response may differ between these outcome variables. Further studies are needed to define the long-term implications of these findings.
在近期的临床试验中，肺减容手术（LVRS）已显示出治疗重度肺气肿患者的前景。然而，由于主观和客观结果之间频繁出现差异，术后反应难以评估。我们评估了145例连续入选双侧胸腔镜肺减容方案的非均匀性肺气肿患者的呼吸困难改善情况与肺功能反应之间的关系，以评估呼吸困难改善结果的预测因素以及主观和客观改善指标的相关性。
术前进行了基线全肺功能测试、肺活量测定、气体交换、体积描记法、气体稀释肺容积测定以及静息呼吸困难指数测定，并在术后短期（平均33天；n = 129）和长期（>6个月；平均276天；n = 84）进行重复测定。
预测的第一秒用力呼气容积（FEV1）百分比的改善与呼吸困难评分的改善显著相关，尽管存在相当大的变异性（短期：r = 0.04，p < 0.01；长期：r = 0.4，p = 0.1）。在这个预先选择的患者组中，那些极度肺过度充气的患者在LVRS术后呼吸困难的改善可能比术前肺过度充气较轻的患者少。呈现的残气量/肺总量比值较低的患者在短期和长期的呼吸困难改善更大（短期：r = 0.4，p = 0.02；长期：r = 0.4，p < 0.05）。
双侧胸腔镜吻合器LVRS可使重度肺气肿和肺过度充气患者在客观和主观上得到显著改善。呼吸困难的改善与肺活量测定的改善之间存在相当大的变异性，并且这些结果变量之间反应的术前预测因素可能不同。需要进一步的研究来确定这些发现的长期意义。
