进胸取膈神经移位术后肺功能的变化

目的　研究进胸取膈神经移位术后患者肺功能的变化。方法　对 5例进胸取膈神经移位患者术前及术后 (8～ 14个月 )肺功能的变化进行比较。结果　 5例在术后均未出现供氧不足症状。 3例出现膈肌抬高 ;术后肺活量 (VC)、肺活量预计值百分数 (VC % )分别比术前减少 17.3 %和 3 2 .3 % ,两者差异有显著性意义 (tvc=3 .49、tvc% =4.17,P <0 .0 5 )。其它项目如残气量 (RV)、肺总量 (TLC)、残气量 /肺总量比值 (RV/TLC)、用力肺活量 (FVC)、1s用力呼气量 (FEV1)、1s用力呼气量 /用力肺活量比值(FEV1/FVC)、5 0 %肺活量的最大呼气流量预计值百分数 (FEF 5 0 % )的变化 ,和术前相比均无明显差异。结论　进胸取膈神经移位术后成人的肺容量有部分丧失 ,但其丧失程度在机体可耐受范围内 ,不会导致呼吸功能障碍     

Pattern of lung volumes in patients with sighing breathing.

BACKGROUND--Sighing breathing is observed in subjects suffering from anxiety with no apparent organic disease. METHODS--Lung volumes and expiratory flow rates were measured in 12 patients with a sighing pattern of breathing and in 10 normal subjects matched for age, gender, and anthropometric data. In both groups the measurements were made by spirographic and plethysmographic techniques. In normal subjects functional residual capacity (FRC) and residual volume (RV) were measured during normal breathing and again during simulated sighing breathing to exclude technical artifacts resulting from hyperventilation during measurement by the helium closed circuit method. RESULTS--Patients with a sighing pattern of breathing had a normal total lung capacity (TLC) but significantly different partitioning of lung compartments compared with normal subjects. The vital capacity (VC) was lower when measured by both spirographic and plethysmographic methods and RV was higher. The forced expiratory volume in one second (FEV1) was also lower in patients with sighing breathing. The FEV1/VC and the maximal expiratory flow rates at 50% and at 25% of the forced vital capacity (V50 and V25) were normal and similar in both groups. In normal subjects there were no differences in RV when measured during quiet or simulated sighing breathing. CONCLUSIONS--Subjects with sighing breathing have a normal TLC with a higher RV and lower VC than normal subjects. There was no obvious physiological or anatomical explanation for this pattern.     

Pulmonary function for pectus excavatum at long-term follow-up

PURPOSE: The aim of this article was to assess whether and to what extent pulmonary function recovered to normal degree postoperatively and to investigate the changes in pulmonary function after surgical correction and the value of surgical correction. METHODS: A total of 27 patients who could be questioned and examined in person at the outpatient department of our hospital were included in this study. Of these patents, 24 were boys and 3 were girls. Their ages ranged from 3 to 16 years (mean, 8.67) at follow-up. The mean age at surgery was 4 years, and mean years of follow-up was 6.8. Pulmonary functional measurements included in vital capacity (VC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV-TLC ratio, maximal voluntary ventilation (MVV), force ventilatory capacity (FVC), forced expiratory volume in one second (FEV1), maximal midexpiratory flow curve (MMEF), maximal expiratory flow in 75% vital capacity (V75), maximal expiratory flow in 50% vital capacity (V50), maximal expiratory flow in 25% vital capacity (V25), and breathing reserve ratio (BR). RESULTS: TLC, FRC, MVV, MMEF, V75, and V50 values were not different from the normal values. IVC, FVC, FEV1, and V25 values were decreased significantly compared with the normal values. The RV and RV-TLC were high in 87.5% cases. CONCLUSIONS: Preoperative symptoms obviously improved after operation. There was little airway obstruction in the patients postoperatively. The patients with pectus excavatum should be operated on as soon as possible.     

Pulmonary function after posterior retroperitoneoscopic surgery

Pulmonary function tests were performed in 12 patients who underwent posterior retroperitoneoscopic surgery, before and on the 3rd and 7th days after operation. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FCV, vital capacity (VC), total lung capacity (TLC), residual volume (RV) and functional residual capacity (FRC) were not significantly different between before and after surgery. It is assumed that posterior retroperitoneoscopic surgery could be performed without impairment of pulmonary function after surgery.     

Respiratory evaluation of patients on continuous ambulatory peritoneal dialysis prior to renal transplantation

BACKGROUND AND AIM: Pulmonary function tests (PFTs) and cardiopulmonary exercise tests (CPETs) are important in predicting preoperative pulmonary complications and mortality rate in potentially renal transplant recipients. There is no adequate clinical research aimed at learning the effect of empty and full status of the peritoneal cavity on PFTs and CPET for estimating decide PFTs and CPET timing in preoperative evaluation. The aim of this study was to investigate whether PFT and CPET results are altered in patients on continuous ambulatory peritoneal dialysis (CAPD) according to the presence of dialysis solution in the abdomen. SUBJECTS AND METHODS: 22 subjects were included (12 male, 10 female, mean age 29.64 +/- 8.29 years, CAPD duration, 37.35 +/- 7.15 months). Data were collected from each patient when the peritoneal cavity was filled with solution (full status) and again when the cavity had been drained (empty status). Forced expiratory volume in 1 s (FEV1), ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC), total lung capacity (TLC), and residual volume (RV) were calculated. Peak oxygen uptake (peak VO2) and exercise duration were determined by cardiopulmonary exercise testing. RESULTS: When the peritoneal cavity was empty, mean (+/- SD) values for the parameters tested were % predicted FEV1: 85 +/- 17%, %FEV1/FVC: 84 +/- 8%, % predicted TLC: 98 +/- 17%, % predicted RV: 108 +/- 25%, % predicted DLCO: 90 +/- 14%, peak VO2: 43 +/- 11 ml/kg/min, test duration: 6.8 +/- 1.6 min. When the peritoneal cavity was full, mean (+/- SD) values were % predicted FEV1: 86 +/- 17%, %FEV1/FVC: 83 +/- 7%, % predicted TLC: 91 +/- 14%, % predicted RV: 95 +/- 22%, % predicted DLCO: 87 +/- 16%, peak VO2: 42 +/- 8 ml/kg/min, test duration 6.5 +/- 1.7 min. % predicted FEV1, %FEV1/FVC, % predicted DLCO and peak VO2 were not statistically significant between the mean values at empty status versus those at full status (p < 0.05 for all). There were significant decreases between the mean values for % predicted TLC and % predicted RV at full status versus empty status (p < 0.002 for TLC, p < 0.001 for RV). No statistically significant correlation was found between PFTs and % change ratio of dialysate. CONCLUSION: FEV1, %FEV1/FVC, % predicted DLCO and CPET test results do not differ according to abdomen status in CAPD patients suggesting that the timing of PFT maneuver does not affect preoperative transplantation evaluation. Therefore, when evaluating the results of these tests prior to transplantation period, the presence of dialysis solution in the abdomen may be ignored.     

Lung mechanics in subjects showing increased residual volume without bronchial obstruction.

Fourteen subjects showing an increase of residual volume (RV) without any clinical or functional signs of bronchial obstruction were studied. Maximum expiratory flow volume (MEFV) curves were obtained with a pressure-corrected volume plethysmograph. Static pressure-volume curves were obtained by stepwise interruption of a slow expiration from total lung capacity (TLC) to RV. Static compliance was measured by the slope of pressure-volume curve between functional residual capacity (FRC) and FRC+20% of TLC. Maximum flow static recoil (MFSR) curves were constructed by plotting MEF obtained from MEFV curves against elastic pressure (Pst) obtained from pressure-volume curves at the same lung volumes. Most patients demonstrated a decrease of MEF 50% and 25% of VC. From the MFSR curves it was clear that this reduction was not the result of increased airways resistance, but rather of loss of elastic recoil. Most patients showed a significant decrease of Pst at different volumes and changes seem likely to be evidence of emphysema.     

Static lung volumes in healthy subjects assessed by helium dilution during occlusion of one mainstem bronchus.

BACKGROUND--Single lung function is usually assessed by radioisotopes or, more rarely, by bronchospirometry in which a double lumen catheter is used to separate ventilation of the two lungs. The latter is more precise but less comfortable. An alternative bronchoscopic method is described for determining the volume of a single lung. METHODS--One mainstem bronchus was temporarily occluded with an inflatable balloon during fibreoptic bronchoscopy in 12 healthy volunteers aged 18-29 years. The functional residual capacities (FRC) of the right, left, and both lungs were measured in duplicate by closed circuit helium dilution. Supplementary vital capacity (VC) manoeuvres permitted calculation of single lung capacities (TLC) and residual volumes (RV). RESULTS--The standard deviation of a single determination of capacities of the right, left, and both lungs were: TLC, 80, 96, and 308 ml; VC, 56, 139, 171 ml; FRC, 131, 74, and 287 ml; RV, 112, 185, and 303 ml, respectively. The sum of the right and left unilateral TLC was not different from bilateral TLC (6.12 v 5.95 l) and the sum of the unilateral FRC was not different from the bilateral FRC (2.60 v 2.78 l). The sum of the unilateral VC was lower than bilateral VC (4.52 v 4.80 l), that of the unilateral RV was higher than bilateral RV (1.60 v 1.16 l). For all subdivisions of lung volume, the right lung was larger than the left. The most common complaint was substernal discomfort during complete exhalation. Oxygen saturation rarely fell below 90%. CONCLUSIONS--Temporary occlusion of a mainstem bronchus in normal subjects is safe, relatively simple, and allows fairly precise and accurate measurements of unilateral static lung volumes. Occlusion at TLC, however, probably prevents proper emptying of the non-occluded lung.     

Lung mechanics after cardiac valve replacement.

Fourteen patients undergoing single aortic or mitral valve replacement had measurements made of lung volumes, static pressure-volume (P-V) relationships, and conductance-pressure relationships during deflation before operation and again between one and two years later. At follow-up, total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), and static tidal compliance (slope of static P-V deflation line for one litre above FRC) had increased significantly, in association with a decrease in heart size. There was a change in the shape and position of some P-V curves both in the aortic and mitral patients. In the patients with aortic disease P-V deflation curves shifted to the left after operation. In the patients with mitral disease the P-V deflation curves before operation crossed those measured after operation, so that at high lung volumes recoil became less after operation, but at low lung volumes recoil increased. Conductance had increased at high lung volumes. The data suggest that in longstanding pulmonary congestion, airways are more rigid making them less distensible at high and less compressible at low transpulmonary pressures than after operation when congestion has been at least partly relieved.     

Effects of inspired gas composition during anaesthesia for abdominal hysterectomy on postoperative lung volumes

We have studied 51 patients who were allocated randomly and prospectively to receive either 100% oxygen (n = 16), 70% nitrous oxide in oxygen (n = 18) or 30% oxygen in nitrogen (n = 17) as the inspired gas during anaesthesia for abdominal hysterectomy. Lung volumes were measured before and after surgery. TLC, VC, FVC and FEV1 but not RV or FRC were reduced after surgery. There were no significant differences between the three treatment groups in any of the lung volumes measured. We conclude that absorption atelectasis during anaesthesia is not the main cause of perioperative changes in lung volume after abdominal hysterectomy. Any effect of the inspired gas is likely to be of limited clinical significance.      

A novel non-invasive technique for measuring the residual lung volume by nitrogen washout with rapid thoracoabdominal compression in infants

BACKGROUND: The functional residual capacity (FRC), the only lung volume to be routinely measured in infants, is an unreliable volume landmark. In addition to FRC, the residual volume (RV) was measured by nitrogen washout using rapid thoracoabdominal compression (RTC) in nine infants with cystic fibrosis aged 5-31 months. METHODS: A commercial system for nitrogen washout to measure lung volumes and a custom made system to perform RTC were used. Lung volume was raised to an airway opening pressure of 30 cm H(2)O (V(30)). RTC was performed from V(30). The jacket pressure (Pj; 65-92 cm H(2)O) which generated the highest forced expiratory volume (mean 40.2 ml/kg; 95% confidence interval (CI) 33.03 to 47.33) was used during the RV manoeuvre. The infants were manually hyperventilated to inhibit the respiratory drive briefly. RTC was initiated during the last passive expiration. RV was estimated by measuring the volume of nitrogen expired after end forced expiratory switching of the inspired gas from room air to 100% oxygen while jacket inflation was maintained at the time of switching into oxygen during the post-expiratory pause. RESULTS: In each infant RV and FRC measurements were reproducible and did not overlap; the difference between mean values, which is the expiratory reserve volume, was statistically significant (p<0.05). Mean RV was 21.3 (95% CI 18.7 to 24.0), FRC was 25.5 (95% CI 22.8 to 28.1), and TLC(30) (total lung capacity at V(30)) was 61.5 (95% CI 54.4 to 68.7) ml/kg. These values were dependent on body length, weight and age. When measuring RV the period between switching to oxygen and the end of the Pj plateau was 0.301 (95% CI 0.211 to 0.391) s. The washout duration was longer for RV than for FRC measurement (80.9 s (95% CI 71.3 to 90.4) versus 72. 4 s (95% CI 64.9 to 79.8)) (p<0.001). CONCLUSIONS: A new non-invasive and reliable technique for routine measurement of RV in infants is presented.     

The diaphragmatic compound muscle action potentials (DCMAPs) at different lung volumes--a prospective electrophysiological study of the respiratory system

Phrenic nerve conduction study and measurements of static lung volumes such as functional residual capacity (FRC), total lung capacity (TLC) and residual volumes (RV) using body plethysmography were carried out in 31 normal healthy male subjects (31 +/- 8 years). The objective was to correlate changes in latency, amplitude, duration and area of diaphragmatic compound muscle action potential (DCMAPs) with lung volumes and changes in them with changes in postures. The mean phrenic nerve latency did not show any significant change with lung volumes or postures, but the latency and height of the subject had a significant correlationship (r = 0.68). The peak to peak amplitude of DCMAP showed a significant relationship with the quantitative lung volumes (r = 0.65). The amplitude was significantly higher and duration reduced (p < 0.001) at TLC as compared with those at measured FRC and RV in both sitting and supine postures. The area under the curve did not change significantly. Similarly, amplitudes and latency did not show any significant relation with other anthropometric parameters. The study evaluates a new quantitative relationship between DCMAPs amplitude and lung volumes. This may be carefully used along with other clinical parameters in critically ill patients for an early weaning from ventilator. Posture exerts minimal influence on DCMAPs amplitude; since DCMAPs amplitudes depends on the position of the diaphragm which in turn depends on dipolic potential, its electromagnetic fields and its moving angle subtends at the recording electrode, one can confidently use it to predict lung volume in respiratory failure due to neuromuscular diseases where subjective lung function assessment is impossible. However, a further study is in process in the critical care unit to confirm its utility.     

Effect of salbutamol on lung function and chest wall volumes at rest and during exercise in COPD

BACKGROUND: Inhaled bronchodilators can increase exercise capacity in chronic obstructive pulmonary disease (COPD) by reducing dynamic hyperinflation, but treatment is not always effective. This may reflect the degree to which the abdomen allows dynamic hyperinflation to occur.Method: A double blind, randomised, crossover trial of the effect of 5 mg nebulised salbutamol or saline on endurance exercise time was conducted in 18 patients with COPD of mean (SD) age 67.1 (6.3) years and mean (SD) forced expiratory volume in 1 second (FEV1) of 40.6 (15.0)% predicted. Breathing pattern, metabolic variables, dyspnoea intensity, and total and regional chest wall volumes were measured non-invasively by optoelectronic plethysmography (OEP) at rest and during exercise. RESULTS: Salbutamol increased FEV1, forced vital capacity (FVC) and inspiratory capacity and reduced functional residual capacity (FRC) and residual volume significantly. OEP showed the change in resting FRC to be mainly in the abdominal compartment. Although the mean (SE) end expiratory chest wall volume was 541 (118) ml lower (p<0.001) at the end of exercise, the endurance time was unchanged by the bronchodilator. Changes in resting lung volumes were smaller when exercise duration did not improve, but FEV1 still rose significantly after active drug. After the bronchodilator these patients tried to reduce the end expiratory lung volume when exercising, while those exercising longer continued to allow end expiratory abdominal wall volume to rise. The change to a more euvolumic breathing pattern was associated with a lower oxygen pulse and a significant fall in endurance time with higher isotime levels of dyspnoea. CONCLUSIONS: Nebulised salbutamol improved forced expiratory flow in most patients with COPD, but less hyper-nflated patients tried to reduce the abdominal compartmental volume after active treatment and this reduced their exercise capacity. Identifying these patients has important therapeutic implications, as does an understanding of the mechanisms that control chest wall muscle recruitment.     

Respiratory function and ribcage contribution to ventilation in body positions commonly used during anesthesia

Lung function tests are normally performed in the upright position, whereas anesthesia is usually administered with the patient in the supine position, and occasionally in other postures. We therefore compared forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), and ribcage contribution to ventilation by respiratory inductive plethysmography in 13 conscious healthy male volunteers, sitting and in four horizontal positions used during anesthesia. Forced vital capacity and FEV1 were similar in all positions, except for a significant mean increase in FVC of 300 mL (SD 213) when sitting compared with when supine (P less than 0.001). The mean decrease in FRC was 806 mL (SD 293) between the sitting and supine positions (P less than 0.001). A significant increase in FRC occurred (252 mL, SD 329, P less than 0.01) when supine subjects raised their arms above their heads as required for computed tomography. Functional residual capacity in the prone and lateral positions was significantly larger than in the supine position (mean change 350 mL, P less than 0.001), but was still some 450 mL less than in the sitting position. Mean ribcage contribution was similar in all horizontal positions (32%-36%), whereas supine values were significantly different from those of the sitting position (mean 70%, SD 11, P less than 0.001). In conclusion, the various horizontal postures studied have no effect on FVC, FEV1, or ribcage contribution to ventilation. However, FRC in the prone, lateral, and arms-up positions is on average 250 mL larger than in the supine position, an observation that may affect gas exchange during anesthesia in these positions.     

The effect of thoracic epidural analgesia on respiratory function after cholecystectomy

To assess the effect of thoracic epidural analgesia (TEA) on postoperative respiratory function and pulmonary complications, a prospective randomized trial was conducted in patients undergoing cholecystectomy. One hundred patients were allocated to TEA (n = 30), TEA + general anesthesia (TEA + GA) (n = 30), or general anaesthesia (GA) (n = 40) groups. Respiratory function was analysed by measuring forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), total lung capacity (TLC), peak expiratory flow (PEF) in the supine and sitting postures, and arterial blood gases. Postoperative pulmonary complications were carefully documented. TEA significantly prevented the postoperative deterioration of respiratory function as compared with general anaesthesia. FVC, FEV1 and PEF decreased by 20% in patients receiving TEA, in contrast to 55% in patients after GA on the day of operation. This improvement continued until the 2nd day after operation, when FVC, FEV1 and PEF and their recovery rates were equal in all groups. In the sitting posture the preoperative FVC, FEV1 and PEF were about 10% greater than in the supine position. After operation, this difference was further increased. The preoperative difference of 27% in FRC between the sitting and supine postures was maintained after operation. PaO2 decreased by 0.8 kPa after TEA, by 1.5 kPa after TEA + GA with the lowest value on the 2nd postoperative day and by 1.5 kPa after GA, with the lowest value immediately after operation. Simultaneous hypercarbia indicated hypoventilation, which may have contributed to impaired respiratory function on the following days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Critical evaluation of computerised x ray planimetry for the measurement of lung volumes.

BACKGROUND--Computerised x-ray planimetry has been advocated as an alternative to body plethysmography and helium dilution for measuring static lung volumes. The accuracy and reproducibility of this method has been assessed in comparison with these standard methods. METHODS--Plethysmographic and planimetric measurements of total lung capacity (TLC) and functional residual capacity (FRC) were made in 10 normal subjects and in 12 patients with chronic obstructive pulmonary disease (COPD), with additional helium dilution measurements in the latter 12 patients. RESULTS--Mean lung volumes (TLC and FRC) for groups of subjects measured by planimetry and by plethysmography were similar in both groups and larger than the helium dilution measurement in patients with COPD. Intraindividual agreement between planimetry and plethysmography was poor, however, with a wide confidence interval (-2.2 to +2.31). The planimeter did not measure reliably changes in volume from TLC to FRC in individuals. CONCLUSIONS--Mean lung volumes measured by planimetry in a group of patients probably reflect a regression to the mean of the computer algorithm rather than accurate TLC estimation. The technique is not yet robust enough to replace the established techniques of helium dilution or plethysmography.     

EFFECT ON LUNG VOLUMES OF OXYGEN CONCENTRATION WHEN BREATHING IS RESTRICTED

We have examined the effect of the fractional concentrationof nitrogen (FlN2) on the decrease in lung volumes which occursduring restricted breathing with oxygen-nitrogen mixtures. Conscioushuman subjects breathed one of five gas mixtures of oxygen andnitrogen for 15 min on each of five occasions. For the final5 min of each 15-min period, functional residual capacity (FRC)was reduced by one tidal volume, by external pressur-ization.After return to normal breathing, the subjects showed a statisticallysignificant decrease in FRC and residual volume (RV), whichbecame larger as F/o increased from 30% to 100%. This reductionin lung volumes was resistant to early re-expansion. The maximumdecrease in both FRC and RV was found with 100% oxygen, andwas 10% of the control lung volumes. The use of a mixture of75 % nitrogen and 25 % oxygen prevented this decrease in lungvolumes. Nitrogen 50% reduced the decrease in FRC, but did notaffect the decrease in RV. The difference in effect on lungvolumes between Fl02 25% and 30% was statistically significant,indicating a watershed area for Fl between 70% and 75%. (Br.J. Anaesth. 1993; 70: 259–266)     

Predictive equations for total lung capacity and residual volume calculated from radiographs in a random sample of the Michigan population.

BACKGROUND: Published predicted values for total lung capacity and residual volume are often based on a small number of subjects and derive from different populations from predicted spirometric values. Equations from the only two large studies gave smaller predicted values for total lung capacity than the smaller studies. A large number of subjects have been studied from a population which has already provided predicted values for spirometry and transfer factor for carbon monoxide. METHODS: Total lung capacity was measured from standard posteroanterior and lateral chest radiographs and forced vital capacity by spirometry in a population sample of 771 subjects. Prediction equations were developed for total lung capacity (TLC), residual volume (RV) and RV/TLC in two groups--normal and total. Subjects with signs or symptoms of cardiopulmonary disease were combined with the normal subjects and equations for all subjects were also modelled. RESULTS: Prediction equations for TLC and RV in non-smoking normal men and women were square root transformations which included height and weight but not age. They included a coefficient for duration of smoking in current smokers. The predictive equation for RV/TLC included weight, age, age and duration of smoking for current smokers and ex-smokers of both sexes. For the total population the equations took the same form but the height coefficients and constants were slightly different. CONCLUSION: These population based prediction equations for TLC, RV and RV/TLC provide reference standards in a population that has provided reference standards for spirometry and single breath transfer factor for carbon monoxide.     

肺气肿兔单侧肺减容术后的肺功能及组织结构变化

目的　评价阻塞性肺气肿兔单侧肺减容术 (LVRS)后的肺功能和组织结构变化 ,并与肺叶切除术比较。方法　 4 0只新西兰大白兔采用烟熏和气管内滴注弹性蛋白酶制成阻塞性肺气肿模型 ,随机分为肺气肿组 (A组 )、单侧LVRS组 (B组 )、肺叶切除组 (C组 )和假手术组 (D组 ) ,每组 10只。 8周后进行肺功能和肺组织学检查。结果　与A组比较 ,B组和C组的潮气量、0 3秒用力呼气容积 (FEV0 3)、FEV0 3 FVC(用力肺活量 )、PaO2 、平均肺泡数和肺泡隔面密度增加 ,功能残气量、PaCO2 、肺总容积和肺泡直径降低 (P <0 0 5 ) ,而D组变化不明显 (P >0 0 5 )。B组和C组肉眼及光镜下可见肺气肿改善 ,而D组无明显变化。B组和C组之间上述各指标差异无显著性 (P >0 0 5 )。结论　单侧LVRS和肺叶切除术均可有效改善阻塞性肺气肿兔的肺功能和组织结构     

Improvement of pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients.

OBJECTIVE: Pulmonary emphysema is frequently associated with lung cancer and, because of the impaired pulmonary function involved, it may contraindicate surgical treatment. However, improvement of pulmonary function has been observed after surgical resection in patients with advanced emphysema. The aim of this study was to evaluate whether pulmonary emphysema, as assessed by pulmonary function tests and radiological evaluation, can influence postoperative respiratory function after lobectomy for non-small cell lung cancer (NSCLC). METHODS: Respiratory function was evaluated before and after lobectomy for NSCLC. Radiological evaluation of emphysema was performed on chest X-ray and CT scan. Patients that had undergone chemo- or radiotherapy or had segmental or lobar atelectasis were excluded from the study. RESULTS: Thirty-five patients entered the study. A decrease in static lung volumes was observed after surgery. Total lung capacity (TLC) decreased from 6.58+/-0.92 to 5.46+/-0.77 l; functional residual capacity (FRC) from 3.70+/-0.88 to 2.96+/-0.73 1 and residual volume (RV) from 2.93+/-0.78 to 2.2+/-0.53 l. However, in a subgroup of 10 patients (Group 1), dynamic volumes after surgery were unchanged or slightly increased (forced vital capacity (FVC) from 3.23+/-0.65 to 3.3+/-0.68 l; forced expiratory volume in 1 s (FEV1) from 2.14+/-0.51 to 2.25+/-0.54 l), and airway resistances (sRaw) decreased from 15.58+/-5.18 to 11.42+/-5.25 cm H2O/s. Preoperative data showed that these patients had a greater obstruction, with FEV1 changing from 69+/-12.42 to 72.70+/-13.72% of predicted, as compared with a change from 87+/-12.7 to 72.08+/-13.10% in the other group of 25 patients (Group 2). Correlation analysis reached statistical significance between FEV1% variation (deltaFEV1%) and preoperative FEV1 and FVC% (r = -0.49, P = 0.002 and r = -0.5, P = 0.001, respectively) and between delta (FEV1)% and radiological scores for 3-level CT (r = 0.39, P = 0.04) and the sum of chest X-ray, single and 3-level CT scores (r = 0.49, P = 0.01). CONCLUSIONS: Pulmonary function may remain unchanged or even increase after lobectomy in patients with a pronounced emphysematous component of airway obstruction. The identification of preoperative parameters that identify this group of patients could extend the indications for the treatment of lung cancer in patients with pulmonary emphysema.     

Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer

BACKGROUND: Although the preoperative prediction of pulmonary complications after lung major surgery has been reported in various papers, it still remains unclear. METHODS: Eighty nine patients with stage I-IIIA non-small cell lung cancer (NSCLC) who underwent a complete resection at our institute from 1994-8 were evaluated for the feasibility of making a preoperative prediction of pulmonary complications. All had either a predicted postoperative forced vital capacity (FVC) of >800 ml/m(2) or forced expiratory volume in one second (FEV(1)) of >600 ml/m(2). RESULTS: Postoperative complications occurred in 37 patients (41.2%) but no patients died during the 30 day period after the operation. Pulmonary complications occurred in 20 patients (22.5%). Univariate analysis indicated that the factors significantly related to pulmonary complications were FVC <80%, serum lactate dehydrogenase (LDH) level > or =230 U/l, and arterial oxygen tension (PaO(2)) <10.6 kPa (80 mm Hg). In a multivariate analysis the three independent predictors of pulmonary complications were serum LDH > or =230 U/l (odds ratio (OR) 10.5, 95% CI 1.4 to 77.3), residual volume (RV)/total lung capacity (TLC) > or =30% (OR 6.0, 95% CI 1.1 to 33.7), and PaO(2) <10.6 kPa (OR 5.6, 95% CI 1.4 to 22.2). CONCLUSIONS: The above findings indicate that three factors (serum LDH levels of > or =230 U/l, RV/TLC > or =30%, and PaO(2) <10.6 kPa) may be associated with pulmonary complications in patients undergoing a lobectomy for NSCLC, even though the patient group was relatively small for statistical analysis of such a diverse subject as pulmonary complications.