肺减容术对慢性阻塞性肺气肿患者肺功能和血管内皮依赖性舒张功能的影响

Reduction Surgery on Lung and Endothelial Function among Patients with Chronic Obstructive Pulmonary Disease

【目的】探讨肺减容术(LVRS)对慢性阻塞性肺疾病(COPD)患者肺功能以及血管内皮功能的影响。【方法】选择2013年2月至2017年6月本院收治的COPD患者62例,根据患者手术耐受性分为观察组和对照组各31例。观察组确诊为末期COPD后即行LVRS术.对照组确诊为末期COPD3个月后行LVRS术。比较两组在COPD诊断当天和随访3个月两个时间点血压、肺功能和内皮依赖性舒张功能(FMD)。【结果】确诊后随访3个月,对照组血压值和肺余气量/肺活量比值增高明显增高、FMD下降;观察组血压值、FEV1预测值、FVC预测值、肺余气量/肺活量比值均较LVRS术前改善明显(P<0.05),而且观察组肺功能指标改善程度均高于对照组(P<0.05).观察组行LVRS术,FEV1或FVC每升高1%,FMD分别提高0.13%和0.11%(P<0.05)。【结论】COPD患者行LVRS术可改善肺功能,并在此基础上进一步提高血管内皮功能。

【Objective】To investigate the effect of lung volume reduction surgery(LVRS)on pulm on ary function and vascular endothelial function in patients with chronic obstructive pulmonary disease(COPD).【Methods】Sixty-two patients with COPD admitted to our hospital from February 2013 to June 2017 were divided into observation group and control group according to their surgical tolerance,with 31 in each group.LVRS was performed in the observation group after the diagnosis of end-stage COPD,and LVRS was performed in the control group 3 months after the diagnosis of end-stage COPD.Blood pressure,pulmonary function and endothelium dependent diastolic function(FMD)were compared between the two groups on the day of COPD diagnosis and at two time points of 3 months follow-up.【Results】After 3 months of follow-up diagnosis,the blood pressure and lung residual volume/lung capacity ratio of the control group increased significantly and FMD decreased.The blood pressure value,FEV1 predictive value,FVC predictive value,lung residual gas volume/lung capacity ratio of the observation group were all improved compared with those before LVRS,the improvement was significant(P<0.05),and the improvement of lung function index in the observation group was higher than that in the control group(P<0.05).The observation group underwent LVRS.For every 1%increase in FEV1 or FVC,FMD increased by 0.13%and 0.11%,respectively(P<0.05).【Conclusion】LVRS in patients with COPD can improve lung function and further improve vascular endothelial function.