运动心肺功能试验在肺手术前后的变化特征

目的:观察不同手术方式、切除范围术后运动心肺功能的变化特征,并根据术前运动心肺功能检测结果及切除肺段数预计患者术后运动心肺功能情况,建立预计方程式.方法:对46例肺切除手术患者进行手术前、手术后3个月常规肺功能及运动心肺功能检查,观察不同病种、手术方式、切除范围术后运动心肺功能的演变特征,并建立术后运动心肺功能指标的预计方程式.结果:肺切除术后所有肺通气功能指标与运动心肺功能指标都较术前有不同程度下降(P＜0.05);恶性肺肿瘤患者,VO2max /kg%pred、VO2/HRmax下降程度比良性肺肿瘤组大(P＜0.05);不同范围肺切除组相比较差异有统计及意义的运动心肺功能指标有:VO2max /kg、VO2max;部分患者手术后运动心肺功能指标较术前有不同程度改善,根据术前、后肺功能差值及手术切除肺段数,建立各个肺功能指标差值A的回归方程(P＜0.05). 结论:肺切除术后肺功能损害主要是以限制性通气功能障碍为主,运动心肺功能指标亦有不同程度下降,术后运动心肺功能与所患疾病严重程度及肺切除范围有关.本研究建立的线性回归方程将有利于指导临床胸外科更安全、有效地开展胸外科手术.

Changes in Postoperative Cardiopulmonary Exercise Performance Following Lung Resection

Objective:To investigate the changes in postoperative cardiopulmonary exercise(CPX) performance following several surgical options and extents of lung resection,and to formulate a predictive equation.Methods: Routine lung function and CPX tests were performed in 46 cases of lung resection before and at 3 months after surgery.Data on diseases leading to surgery,treatment options,extent of lung resection,and change in postoperative CPX performance were analyzed and used to formulate an equation predictive of CPX outcomes after operation.Results: Compared with baseline,all parameters in lung ventilation function and CPX tests showed varied declines postoperatively(all P<0.05).VO2max/kg%pred and VO2/HRmax saw greater decrease in patients with malignancy vs with benign disorders.Significant differences in VO2max/kg and VO2max were noted among other CPX parameters,on which groups with varied extent of resection were compared.Some patients were found to present with better CPX outcomes than before.Based on changes in post-operative lung function and numbers of lung segments resected,regression eguations predictive of declines(value A)in lung function measures were successfullly formulated(P<0.05). Conclusion: Pulmonary function damage after lung resection was shown to be largely associated with restricted pulmonary ventilation,along with some degree of decline in CPX performance.While change in postoperative CPX outcomes appears to be correlated with severity of the diseases and extent of lung resection,the equation established in this study may be useful as a guidance towards more effective and safer tho,jracic surgery.