6分钟步行试验在肺叶切除术患者术前评估中的应用北大核心CSCD

目的分析术前6分钟步行试验(6MWT)在肺叶切除术前评估应用的可行性及其对术后结局的预测价值。方法回顾性分析2017年5月至2019年5月在本院肺二科住院的580例患者,筛查出符合条件的274例,所有患者均为首次手术且手术方式均为肺叶切除术。通过术前6MWT结果将患者分为两组,6分钟步行距离(6MWD)的临界值通过接受者操作特征曲线(ROC)的曲线下最大面积(AUC)获得,分析两组术后恢复及心肺并发症的发生情况。结果与6MWD>449 m的患者比较,6 MWD≤449 m的患者年龄显著增加(P<0.001),第一秒用力呼气量(FEV1)较小(P<0.05),其他如手术切除部位、病理分期、性别等无显著性差异(P>0.05);术后心肺并发症的发生率明显增加(OR=2.672, 95%CI 1.488~4.798, P=0.002),术后拔管时间和住院天数增加(P<0.05)。6MWD≤449 m是术后心肺并发症的独立危险因素(OR=2.395, 95%CI 1.299~4.415, P=0.005)。结论 6MWT作为一种简易的运动功能测试,可常规应用于肺叶切除术患者术前的生理功能评估。当6MWD≤449 m时,患者术后发生心肺并发症的风险较高。

Application of six-minute walk test in preoperative evaluation of patients undergoing pulmonary lobectomy

Objective To analyze the feasibility of six-minute walk test(6 MWT) before pulmonary lobectomy and prediction for postoperative outcome.Methods A total of 580 patients who were hospitalized in the department of lung surgery from May,2017 to May,2019 were reviewed,and 274 eligible patients were selected,who underwent first surgery and the surgical method was pulmonary lobectomy.They were divided into two groups based on the results of 6 MWT before operation.The cut-off value of six-minute walk distance(6 MWD) was obtained by receiver operating characteristic curve(ROC) area under curve(AUC).The postoperative outcome and the occurrence of cardiopulmonary complications in the two groups were analyzed.Results Compared to patients with 6 MWD > 449 meters,the age was significantly older(P < 0.001),the forced expiratory volume in the first second(FEV1) was poor in patients with 6 MWD ≤ 449 meters(P < 0.05),and other factors such as surgical resection site,pathological stage,gender,etc.,were not significantly different(P > 0.05).The incidence of postoperative cardiopulmonary complications was significantly higher(OR = 2.672,95%CI 1.488 to4.798,P = 0.002),and the postoperative extubation time and hospital stay was longer in patients with 6 MWD ≤449 meters than in patients with 6 MWD > 449 meters(P < 0.05).6 MWD ≤ 449 meters was an independent risk factor for postoperative cardiopulmonary complications(OR = 2.395,95%CI 1.299 to 4.415,P = 0.005).Conclusion As a simple function test,6 MWT can be routinely used to assess the physiological function of patients undergoing pulmonary lobectomy.Patients with 6 MWD ≤ 449 meters may be in higher risks of postoperative cardiopulmonary complications.