运动负荷试验对胸部手术患者心肺储备功能分析的意义

Change in cardiopulmonary functional reserve after thoracic surgery assessed by treadmill exercise test

目的 分析运动负荷试验对胸部手术患者心肺储备功能分析的意义。方法 对 5 6例胸部手术患者手术前后进行阶段踏车运动负荷试验 ,分析其心肺功能的变化。结果 与术前相比术后由于运动氧分压低下者增多 ,在单侧肺切除组氧分压全部低下 ,被认为与肺组织切除量有关。在运动终点上 ,由于呼吸症状而终止运动的例数增多 ,其中氧分压低下者亦增多。与其他原因终止运动的患者相比 ,术前第 1秒未用力呼气量 (FEV 1)低下 ,术后肺一氧化碳弥散功能 (DL co)低下提示术前由于通气功能障碍所致 ,而术后由于换气功能障碍所致。作为需氧运动能力的厌氧代谢阈值与术式无关 ,而主动最大氧气摄入量与肺切除量有关。结论 在运动负荷试验中因呼吸系统症状而停止运动的患者增多。主要是由于肺换气功能障碍导致的低氧血症所致 ,评价胸部手术患者心肺储备功能不仅要测定厌氧代谢阈值 ,主动最大氧气摄入量也非常重要。

Objective Evaluate the effect of thoracic surgery on cardiopulmonary functional reserve using a four-minute incremental test on treadmill before and after the surgery.Methods Fifty-six patients undergoing thoracic surgery were divided into two groups according to the presence or absence of respiratory symptoms during the exercise test.Before operation,1 month and 6 months after operation,the anaerobic threshold (AT),symptom-limited maximal oxygen consumption (VO 2max),blood gas,vital capacity (VC),forced expiratory volume in 1 second (FEV1),maximal voluntary ventilation (MVV),diffusion capacity (DLco) were measured.Results The number of patients who halted the test because of respiratory symptoms (group A) increased after operation;patients in group A showed significantly lower FEV1 than those who halted the test because of other symptoms (group B).Postoperative patients in group A showed a significantly lower % DLco than those in group B,the decrease was characteristic for patient with respiratory symptoms.The VO 2max was significantly lower in patients undergoing pneumonectomy as compared with that in patients undergoing lobectomy.Patients undergoing thoracotomy only showed significantly higher VO 2max values than those of patients undergoing lobectomy.Conclusion Hypoxemia during exercise induced by reduced ventilation function may be responsible for patient′s respiratory symptoms;the measurement of expired gas exchange,blood gas analysis,VO 2max and AT on treadmill exercise test is a useful method for the evaluation of cardiopulmonary function reserve in patients before and after thoracic surgery.