AIM:To investigate the prevalence of chronic dyspnea and its relationship to respiratory muscle function in end-stage liver disease.METHODS:Sixty-eight consecutive,ambulatory,Caucasian patients with end-stage liver di...AIM:To investigate the prevalence of chronic dyspnea and its relationship to respiratory muscle function in end-stage liver disease.METHODS:Sixty-eight consecutive,ambulatory,Caucasian patients with end-stage liver disease,candidates for liver transplantation,were referred for preoperative respiratory function assessment.Forty of these(29 men) were included in this preliminary study after applying strict inclusion and exclusion criteria.Seventeen of 40 patients(42%) had ascites,but none of them was cachectic.Fifteen of 40 patients(38%)had a history of hepatic encephalopathy,though none of them was symptomatic at study time.All patients with a known history and/or presence of co-morbidities were excluded.Chronic dyspnea was rated according to the modified medical research council(mMRC) 6-point scale.Liver disease severity was assessed according to the Model for end-stage liver disease(MELD).Routine lung function tests,maximum static expiratory(Pemax) and inspiratory(Pimax) mouth pressures were measured.Respiratory muscle strength(RMS) was calculated from Pimax and Pemax values.In addition,arterial blood gases and pattern of breathing(VE:minute ventilation;VT:tidal volume;VT/TI:mean inspiratory flow;TI:duration of inspiration) were measured.RESULTS:Thirty-five(88%) of 40 patients aged(mean ± SD) 52 ± 10 years reported various degrees of chronic dyspnea(mMRC),ranging from 0 to 4,with a mean value of 2.0 ± 1.2.MELD score was 14 ± 6.Pemax,percent of predicted(%pred) was 105 ± 35,Pimax,%pred was 90 ± 29,and RMS,%pred was 97 ± 30.These pressures were below the normal limits in 12(30%),15(38%),and 14(35%) patients,respectively.Furthermore,comparing the subgroups of ascites to non-ascites patients,all respiratory muscle indices measured were found significantly decreased in ascites patients.Patients with ascites also had a significantly worse MELD score compared to non-ascites ones(P = 0.006).Significant correlations were found between chronic dyspnea and respiratory muscle function indices in all patients.Specific展开更多
Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients...Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients were prospectively enrolled. The enrollment criteria were FEV1.0% 8 by the Goddard classification or interstitial pneumonia on chest computed tomography. Patients underwent testing for pulmonary function, six-minute walking test (6MWT), and stair-climbing test (SCT). Postoperative cardiopulmonary complications (PCPCs) were recorded. Results: Four patients developed PCPCs. There were no significant differences between the patients with PCPCs (n = 4) and those without PCPCs (n = 9) for background data and PFT. The distances achieved in the 6MWT were 503 ± 72.7 m for patients without PCPCs and 369 ± 50.7 m for patients with PCPCs (p = 0.011). The SCT climbing heights were 20.4 ± 5.3 m for patients without PCPCs and 14.9 ± 4.0 m for patients with PCPCs (P = 0.187). Cut-off points, including a 6MFT distance of less than 400 m, SCT height lower than 15 m, and SCT climbing speed less than 8.5 m/min, were predictive of CPCP. Conclusions: Exercise testing is more feasible for predicting postoperative cardiopulmonary complications than stationary pulmonary function testing.展开更多
背景与目的肺癌是慢性阻塞性肺疾病(慢阻肺)重要的合并症,会显著影响慢阻肺患者的预后。慢阻肺也会影响肺癌患者的术后并发症和复发。本研究旨在调查胸外科住院肺癌合并慢阻肺的情况。方法回顾性分析北京大学人民医院胸外科2015年1月-2...背景与目的肺癌是慢性阻塞性肺疾病(慢阻肺)重要的合并症,会显著影响慢阻肺患者的预后。慢阻肺也会影响肺癌患者的术后并发症和复发。本研究旨在调查胸外科住院肺癌合并慢阻肺的情况。方法回顾性分析北京大学人民医院胸外科2015年1月-2015年12月收治的原发性非小细胞肺癌患者。通过查阅病历获取患者的性别、年龄、吸烟状况、有害职业史、症状、胸部计算机断层扫描(computed tomography,CT)、术后病理、出院诊断、全套肺功能及支气管舒张试验,当基础肺功能第一秒钟用力呼气容积(forced expiratory volume in one second,FEV_1)占预计值<70%时即行支气管舒张试验。结果 703例肺癌患者进行了全套肺功能测定,其中67例进行支气管舒张试验,62例(92.5%)符合慢阻肺诊断。接受手术治疗的肺癌患者有677例,其中41例进行支气管舒张试验,38例(92.7%)符合慢阻肺诊断。在接受手术治疗的肺癌患者中合并慢阻肺者年龄≥65岁、男性、有吸烟史和非腺癌的比例高于未合并慢阻肺者,差异有统计学意义(P<0.05);男性和≥65岁者更易合并慢阻肺(OR:2.807-2.374,95%CI:1.101-7.157)(P<0.05)。住院前仅有3例(4.3‰)诊断慢阻肺并按慢阻肺规范治疗。出院时仅有5例(7.1‰)诊断慢阻肺。结论在胸外科住院肺癌患者中行常规肺功能及支气管舒张试验可提高肺癌合并慢阻肺的诊断;当前肺癌合并慢阻肺诊断和治疗严重不足,需要引起胸外科医生重视,与呼吸内科医生携手共同防治慢阻肺。展开更多
文摘AIM:To investigate the prevalence of chronic dyspnea and its relationship to respiratory muscle function in end-stage liver disease.METHODS:Sixty-eight consecutive,ambulatory,Caucasian patients with end-stage liver disease,candidates for liver transplantation,were referred for preoperative respiratory function assessment.Forty of these(29 men) were included in this preliminary study after applying strict inclusion and exclusion criteria.Seventeen of 40 patients(42%) had ascites,but none of them was cachectic.Fifteen of 40 patients(38%)had a history of hepatic encephalopathy,though none of them was symptomatic at study time.All patients with a known history and/or presence of co-morbidities were excluded.Chronic dyspnea was rated according to the modified medical research council(mMRC) 6-point scale.Liver disease severity was assessed according to the Model for end-stage liver disease(MELD).Routine lung function tests,maximum static expiratory(Pemax) and inspiratory(Pimax) mouth pressures were measured.Respiratory muscle strength(RMS) was calculated from Pimax and Pemax values.In addition,arterial blood gases and pattern of breathing(VE:minute ventilation;VT:tidal volume;VT/TI:mean inspiratory flow;TI:duration of inspiration) were measured.RESULTS:Thirty-five(88%) of 40 patients aged(mean ± SD) 52 ± 10 years reported various degrees of chronic dyspnea(mMRC),ranging from 0 to 4,with a mean value of 2.0 ± 1.2.MELD score was 14 ± 6.Pemax,percent of predicted(%pred) was 105 ± 35,Pimax,%pred was 90 ± 29,and RMS,%pred was 97 ± 30.These pressures were below the normal limits in 12(30%),15(38%),and 14(35%) patients,respectively.Furthermore,comparing the subgroups of ascites to non-ascites patients,all respiratory muscle indices measured were found significantly decreased in ascites patients.Patients with ascites also had a significantly worse MELD score compared to non-ascites ones(P = 0.006).Significant correlations were found between chronic dyspnea and respiratory muscle function indices in all patients.Specific
文摘Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients were prospectively enrolled. The enrollment criteria were FEV1.0% 8 by the Goddard classification or interstitial pneumonia on chest computed tomography. Patients underwent testing for pulmonary function, six-minute walking test (6MWT), and stair-climbing test (SCT). Postoperative cardiopulmonary complications (PCPCs) were recorded. Results: Four patients developed PCPCs. There were no significant differences between the patients with PCPCs (n = 4) and those without PCPCs (n = 9) for background data and PFT. The distances achieved in the 6MWT were 503 ± 72.7 m for patients without PCPCs and 369 ± 50.7 m for patients with PCPCs (p = 0.011). The SCT climbing heights were 20.4 ± 5.3 m for patients without PCPCs and 14.9 ± 4.0 m for patients with PCPCs (P = 0.187). Cut-off points, including a 6MFT distance of less than 400 m, SCT height lower than 15 m, and SCT climbing speed less than 8.5 m/min, were predictive of CPCP. Conclusions: Exercise testing is more feasible for predicting postoperative cardiopulmonary complications than stationary pulmonary function testing.
文摘背景与目的肺癌是慢性阻塞性肺疾病(慢阻肺)重要的合并症,会显著影响慢阻肺患者的预后。慢阻肺也会影响肺癌患者的术后并发症和复发。本研究旨在调查胸外科住院肺癌合并慢阻肺的情况。方法回顾性分析北京大学人民医院胸外科2015年1月-2015年12月收治的原发性非小细胞肺癌患者。通过查阅病历获取患者的性别、年龄、吸烟状况、有害职业史、症状、胸部计算机断层扫描(computed tomography,CT)、术后病理、出院诊断、全套肺功能及支气管舒张试验,当基础肺功能第一秒钟用力呼气容积(forced expiratory volume in one second,FEV_1)占预计值<70%时即行支气管舒张试验。结果 703例肺癌患者进行了全套肺功能测定,其中67例进行支气管舒张试验,62例(92.5%)符合慢阻肺诊断。接受手术治疗的肺癌患者有677例,其中41例进行支气管舒张试验,38例(92.7%)符合慢阻肺诊断。在接受手术治疗的肺癌患者中合并慢阻肺者年龄≥65岁、男性、有吸烟史和非腺癌的比例高于未合并慢阻肺者,差异有统计学意义(P<0.05);男性和≥65岁者更易合并慢阻肺(OR:2.807-2.374,95%CI:1.101-7.157)(P<0.05)。住院前仅有3例(4.3‰)诊断慢阻肺并按慢阻肺规范治疗。出院时仅有5例(7.1‰)诊断慢阻肺。结论在胸外科住院肺癌患者中行常规肺功能及支气管舒张试验可提高肺癌合并慢阻肺的诊断;当前肺癌合并慢阻肺诊断和治疗严重不足,需要引起胸外科医生重视,与呼吸内科医生携手共同防治慢阻肺。
