术前肺功能评估.docx

术前肺功能评估.docx

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术前肺功能评估

Record1fromdatabase:

MEDLINE

Title

Temporarymainbronchialocclusionunderbronchoscopiccontrolinthe

evaluationofcandidatesforpneumonectomy.

Author

MelloniG;ZanniniP;CarrettaA;ChiesaG;GrossiA

Address

InstituteforCardiovascularandRespiratoryDisease,UniversityofMilan

ScientificInstituteSanRaffaeleHospital,Italy.

Source

IntSurg,1997Jan,82:

1,34-7

Abstract

BACKGROUND:

Inthisstudywereportourexperiencewith

temporarymainbronchialocclusioninthepreoperativeevaluationof

candidatesforpneumonectomy.METHODS:

BetweenJanuary1991

andJanuary1994,57candidatesforpneumonectomyunderwenta

15-minutetemporarymainbronchialocclusionwithaninflatableballoon

duringfiberopticbronchoscopy.Thefollowingparameterswere

monitoredduringbronchialocclusion:

generalstatus,ECG,arterial

pressure,heartrateandrespiratoryrate.Arterialbloodgaseswere

measuredafter7and14minutes.Valuesat7andat14minuteswere

comparedwiththoseobtainedbeforetheprocedure.Patientswere

consideredsuitablesurgicalcandidatesforpneumonectomyifPaCO2<

42mmHgandpH>7.35.RESULTS:

Fifty-threepatientswere

consideredfunctionallyoperable.Threepatientswereconsidered

functionallyinoperable（PaCO2>42mmHg,pH<7.35and

appearanceofdyspnea）.Onepatientwasexcludedfromtheanalysis

becauseofballoonmispositioningduetoacoughingfit.Sixteenofthe

operablepatientsunderwentpneumonectomyandalldidwellwithout

clinicalevidenceofrespiratoryinsufficiency.Atpresent11patientsare

alive,allwithoutchronicrespiratoryinsufficiency（meanfollow-up14

months）.Nopostoperativemortalityrelatedtocardiorespiratory

problemswasobserved.CONCLUSIONS:

Temporarymainbronchial

occlusionisasimpleandinexpensivetestthatcancorrectlypredict

functionalresectabilityincandidatesforpneumonectomy.

Record2fromdatabase:

MEDLINE

Title

Preoperativeassessmentofthehigh-riskpatientforlungresection.

Author

PateP;TenholderMF;GriffinJP;EastridgeCE;WeimanDS

Address

DepartmentofMedicine,UniversityofTennessee,Memphis38163,

USA.

Source

AnnThoracSurg,1996May,61:

5,1494-500

Abstract

BACKGROUND.Wewantedtodetermineifcardiopulmonaryexercise

testingcouldbetteridentifythethresholdwherephysiologicfunctionis

irreparablyimpairedforpatientswithborderlinepulmonaryfunctionwho

arebeingconsideredforlungcancerresection.METHODS.We

performedanopen,prospectivepreoperativetrialandapostoperative

outcomeevaluationwithacombinedmedical,surgical,andexercise

physiologyevaluationatthreeuniversityhospitals.Alleligiblepatients

hadspirometry,lungvolumedetermination,andquantitativeperfusion

scanningandperformedacardiopulmonarystresstest,stairclimbing,

anda12-minutewalkfordistance.Functionalstatuswasdetermined

withanEasternCooperativeOncologyGroupscore,adyspneascore,

andacardiopulmonaryriskindex.RESULTS.Weidentified12patients

whometstrictcriteriaforborderlinepulmonaryfunctionduringa1-year

studyperiod.Themeanforcedexpiratoryvolumein1second（FEV1）

was1.38L（48%ofpredicted）.Themeanpredictedpostoperative

FEV1basedonpneumonectomywas700mL.Elevenofthepatients

didthestairclimband10passed.All12patientsachievedamaximum

oxygenconsumptiongreaterthanorequalto10mLxkg（-1）xmin（-1）

（meanvalue,13.8mLxkg（-1）xmin（-1））.Thirteenoperationswere

performedonthe12patients.Ninecomplicationsoccurredin7patients.

CONCLUSIONS.Patientswithborderlinepulmonaryfunctioncan

undergoresectionsafelyiftheyhaveanFEV1equaltoorgreaterthan

1.6Lor40%ofitspredictedvalue,apredictedpostoperativeFEV1of

700mLormore,amaximumoxygenconsumptionof10mLxkg（-1）x

min（-1）orgreater,orstairclimbingofthreeflightsormore.

Cardiopulmonarystresstestingandstairclimbingaddvaluableclinical

informationforpatientswithanFEV1oflessthan1.6L.

Record3fromdatabase:

MEDLINE

Title

Preoperativeechocardiographicevaluationofpatientsreferredforlung

volumereductionsurgery.

Author

BachDS;CurtisJL;ChristensenPJ;IannettoniMD;WhyteRI;

KazerooniEA;ArmstrongW;MartinezFJ

Address

DepartmentofInternalMedicine,UniversityofMichiganMedical

Center,AnnArbor,USA.

Source

Chest,1998Oct,114:

4,972-80

Abstract

BACKGROUND:

Themostefficientpreoperativeassessmentforlung

volumereductionsurgery（LVRS）inpatientswithadvancedemphysema

isundefined.Thisstudyanalyzedthepreoperativeassessmentofpatients

bysurfaceechocardiography（withoutandwithdobutamineinfusion）,the

resultsofwhichwereusedtoexcludepatientswithsignificant

pre-existingcardiacdisease,acontraindicationtoLVRS,fromthe

surgery.SETTING:

Auniversity-based,tertiarycarereferralcenter.

METHODS:

PatientswithemphysemawhometinitialLVRSscreening

criteriaunderwentrestingandstresssurfaceechocardiographywith

Dopplerimaging.Patientswereevaluatedprospectivelyforperioperative

cardiaccomplications.RESULTS:

BetweenJuly1994andDecember

1996,503candidatesforLVRSwereevaluated.Ofthese,207patients

（81.8%）whohadechocardiographyperformedatourinstitutionformed

theprimarystudygroup.Imageswereadequatefortheanalysisof

chambersizesandfunctionin206patients（99.5%）undergoingresting

echocardiography,andtheimageswereadequateforwallmotion

analysisin172of174patients（98.9%）undergoingfunctionaltesting.

Rightheartabnormalitieswerecommon（40.1%）.Significantpulmonary

hypertension（>35mmHg）wasuncommon（5patients,5.4%）among

the92patientswhosubsequentlyunderwentrightheartcatheterization.

Occultischemia,leftventriculardysfunction,andvalvularabnormalities

alsowereuncommon.Thus,althoughDopplerimagingestimatesofright

ventricularsystolicpressurewereimperfect,echocardiographicfindings

ofnormalrightheartanatomyandfunctionexcludedsignificant

pulmonaryhypertension.Ninetypatients（43%）eventuallyunderwent

LVRS（70bilateraland20unilateral）.Atotalof13perioperative

cardiaceventsoccurredin10patients,6ofwhomhadundergone

preoperativeechocardiography.Nopatientsufferedacutemyocardial

infarctionorcardiacdeath.CONCLUSIONS:

Despitepotential

limitationsduetosevereobstructivelungdisease,surface

echocardiographicimagingisafeasible,noninvasivetoolinthispatient

populationtoidentifypatientswithevidenceofcorpulmonalethat

suggestspulmonaryhypertension.Theroutineuseofsurfacerestingand

stressechocardiographyforpreoperativescreeningobviatestheneedfor

invasiverightheartcatheterizationinmanypatientsandresultsinalow

incidenceofsignificantperioperativecardiaccomplications.

Record4fromdatabase:

MEDLINE

Title

Prospectiveevaluationofanalgorithmforthefunctionalassessmentof

lungresectioncandidates.

Author

WyserC;StulzP;SolèrM;TammM;MüllerBrandJ;HabichtJ;

PerruchoudAP;BolligerCT

Address

RespiratoryDivision,DepartmentofInternalMedicine,Cardio-Thoracic

Unit,DepartmentofSurgery,UniversityHospital,Basel,Switzerland.

Source

AmJRespirCritCareMed,1999May,159:

5Pt1,1450-6

Abstract

Patientswithimpairedpulmonaryfunctionareatincreasedriskforthe

developmentofpostoperativecomplications.Recentlyexercisetesting

andpredictedpostoperative（ppo）functionhavegainedincreasing

importanceintheevaluationoflungresectioncandidates.We

prospectivelyevaluatedanalgorithmforthepreoperativefunctional

evaluationthatwasdevelopedatourinstitution.Thisalgorithm

incorporatedthecardiachistoryincludinganelectrocardiogram（ECG）,

andthethreeparametersFEV1,diffusingcapacityofthelungsfor

carbonmonoxide（DLCO）,andmaximaloxygenuptake（VO2max）,as

wellastheirrespectiveppovalues（FEV1-ppo,DLCO-ppo,and

VO2max-ppo）calculatedbasedonradionuclideperfusionscans.A

consecutivegroupof137patients（meanage62yr;range23to81;102

males,35females）withclinicallyresectablelesionsunderwent

assessmentaccordingtoouralgorithm.Fivepatientsweredeemed

functionallyinoperable,132passedthealgorithmandunderwent

pulmonaryresectionswithstandardthoracotomy:

9segmentalorwedge

resections,85lobectomies（inclusive3bilobectomies）,and38

pneumonectomies.Allpatientswereextubatedwithin24h.Themean

stayintheICUwas1.4（+/-1.8）d,andthemeanhospitalstaywas

14.6（+/-5）d.Postoperativecomplications（within30d）occurredin15

patients（11%）,ofwhomtwodied（overallmortalityrate1.5%）.In

comparisontoourpreviousseriesthismeanta50%reductionin

complicationswhereasthepercentageofinoperablepatientsremained

unchanged（4%now,5%before）.Weconcludethatadherencetoour

algorithmresultedinaverylowcomplicationrate（morbidityand

mortality）,andexcludedmorerigorouspatientselectionasabiasforthe

improvedresults.

Record5fromdatabase:

MEDLINE

Title

Lungvolumereductionsurgeryaltersmanagementofpulmonarynodules

inpatientswithsevereCOPD.

Author

OjoTC;MartinezF;PaineR3rd;ChristensenPJ;CurtisJL;WegJG;

KazerooniEA;WhyteR

Address

DivisionofPulmonaryandCriticalCareMedicine,Universityof

MichiganMedicalCenter,AnnArbor48109-0326,USA.

Source

Chest,1997Dec,112:

6,1494-500

Abstract

OBJECTIVE:

Toexaminetheroleoflungvolumereductionsurgery

（LVRS）inexpandingthetreatmentoptionsforpatientswith