Cengiz GEBİTEKİN, Ahmet Sami BAYRAM, Hüseyin DÜLGER, Tarık CANDAN, Metin ÖZCAN, Muharrem EROL

Akciğer rezeksiyonları sonrası komplikasyon tahmininde maksimal oksijen tüketim testinin önemi

Amaç: Akciğer rezeksiyonu yapılan olgularda ameliyat sonrası dönemde gelişen komplikasyonlar alınan tüm tedbirlere rağmen halen önemli bir sorun olmaya devam etmektedir. Bu komplikasyonlarm gelişiminde, ameliyat öncesi tahminde en yararlı testin hangisi olduğu konusunda görüş birliği yoktur. Bu çalışmada maksimal egzersiz oksijen tüketim kapasitesinin postoperatif mortalite ve morbiditeyi tahmindeki önemini ortaya koymayı ve "standart solunum fonksiyon testi" ile bu alandaki rollerini karşılaştırmayı amaçladık. Mataryel ve Metod: Çalışmaya majör akciğer rezeksiyonu öncesi her iki testin uygulandığı toplam 55 olgu (49 olgu erkek, 6 olgu kadın) dahil edildi. Olgular egzersiz testi sonuçlarına göre VO2 max değerleri 15 mL/kg/dak'nın altında (V,) ve üstünde (V2); solunum fonksiyon testi ile yapılan değerlendirmeye göre FEVj değeri 2 litrenin altında (St) ve üstünde (S2) olmak üzere dört gruba ayrıldı. Ortalama yaş 56 olarak bulundu (20-74 yaş arası).Bulgular: Toplam 2 olguda (%3.6) mortalite gelişti. Toplam 19 olguda (%34.5) morbidite gelişti. Egzersiz VO2max değeri 20 mL/kg/dak'dan fazla olan olguların hiçbirinde mortalite veya morbidite gelişmedi. Sonuç: Oksijen tüketim kapasitesinin ölçümü, majör akciğer rezeksiyonları sonrası gelişebilecek komplikasyonlarm tahmininde ve mortalite riski yüsek hastaların seçilmesinde yeni ve güvenilir bir testtir.

The importance of maximal oxygen consumption test in the estimation of complications following postoperative lung resections

Background: In the preoperative period, routine "pulmonary function testing" (PFT) and "symptom-limited exercise testing" were applied to the patients, who were planned to have "major lung resection", to evaluate the importance of maximum oxygen consumption in predicting postoperative mortality and morbidity. Methods: This study included 55 patients (49 male and 6 female) who under went major lung resection. According to the results of the exercise tests, patients were divided into two groups as the ones with VO2max value lower (Vt) or higher (V2) than 15 mL/kg/min. On the other hand, the results of the PFT lead to a segregation of patients as those whose FEV1 values were lower than 2 liters (S,)and those with FEV, values higher than 2 liters (S2). The mean age of cases was 56 years (20-74). Results: A total of 2 patients (3.6%) had mortality. A total of 19 patients (34.5%) had morbidity. None of the patients with VO2max value higher than 20 mL/kg/min had mortality or morbidity. Conclusions: Measurement of maximal oxygen consumption has successfully predicted postoperative mortality morbidity.

PDF

___

1) Olsen GN . Pulmonary physiologic assessment of operative risk. In: Shields TW, LoCiceroIII J, Ponn RB, eds. General Thoracic Surgery. New York: Lipincott Williams, 2000;297-304.
2) Karadağ M. Akciğerlerin preoperatif değerlendirilmesi. Özyardımcı N, ed. Nonspesifik Akciğer Hastalıkları. Bursa: Uludağ Üniversitesi Basım Evi, 1999;273-87.
3) Smith PK, Wolfe WG. Preoperative assessment of pulmonary function: Quantitative evaluation of ventilation and blood gas exchange. In: Sabiston DC, Spancer FC, eds. Surgery of the Chest. Philadelphia: WB Saunders Company, 1995;1-21.
4) Gass GD, Olsen GN. Preoperative pulmonary function testing predict postoperative morbidity and mortality. Chest 1986;89:127-35.
5) Ninan M, Sommers KE, Landrenau RJ, et al. Standardized exercise oximetry predicts postpneumonectomy outcome. Ann Thorac Surg 1997;64:328-33.
6) Nakagawa K, Nakahara K, Miyoshi S, Kawashima Y. Oxygen transport during incremental exercise load as a predictor of operative risk in lung cancer patients. Chest 1992;101:1369-75.
7) Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999;115:58-63.
8) Olsen GN. The evolving role of exercise testing prior to lung resection. Chest 1989;95:218-25.
9) Reilly JJ. Preoperative and postoperative care of standart and high-risk surgical patients. Hematol Oncol Clin North Am 1997;11:449-59.
10) Tisi GM. Preoperative identification and evaluation of the patient with lung disease. Med Clin North Am 1987;71:399-412.
11) Walsh GL, Rodolfo CM, Putnam JB, et al. Resection of lung cancer is justified in high-risk patients selected by exercise oxygen consumption. Ann Thorac Surg 1994;58:704-11.
12) Pate P, Tenholder MF, Griffin JP, Eastridge CE, Weisman DS. Preoperative assessment of the high-risk patient for lung resection. Ann Thorac Surg 1996;61:1494-500.
13) Smith TP, Kinasewits GT, Tucker WY, Spillers WP, George RB. Exercise capacity as a predictor of post-thoracotomy morbidity. Am Rev Respir Dis 1984;129:730-34.
14) Walsh GL, Rodolfo CM, Putnam JB. Resection of lung cancer is justified in high-risk patient selected by exercise consumption. Ann Thorac Surg 1994;58:704-11.
15) Bolliger CT, Soler M, Stults P. Evaluation of high-risk lung resection candidates: Pulmonary hemodynamics versus exercise testing. Respiration 1994;61:181-6.
16) Eugene J. Maximum oxygene consumption: A phisiologic guide to pulmonary resection. Surg Forum 1982;33:260-2.
17) Bechard D, Wetstein L. Assessment of exercise oxygene consumption as preoperative criterion for lung resection. Ann Thorac Surg 1987;44:344-9.
18) Morise RC, Peters EJ, Ryan MB. Exercise testing in the evaluation of patients at high risk for complications from lung resection. Chest 1992;101:356-61.
19) Gilbreth EM, Weisman IM. Role of exercise stress testing in preoperative evaluation of patients for lung resection. Clin Chest Med 1994;15:389-403.