Risk stratification before thoracic surgery, perioperative pulmonary rehabilitation
Risk stratification before thoracic surgery, perioperative pulmonary rehabilitation
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DOI：
10.1556/650.2017.30862
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发表时间：
2017-12-01
期刊：
影响因子：
0.6
通讯作者：
Varga Janos Tamas
中科院分区：
文献类型：
--
作者：
Vagvolgyi Attila;Rozgonyi Zsolt;Varga Janos Tamas
前言：肺癌手术的可操作性除与肿瘤学和手术技术有关外，还受功能因素的影响。术前风险分层，术后并发症的评估需要考虑。目的：回顾国际文献和我所的经验。方法：我们重点查阅有关胸部手术风险分层的文献。考虑肺功能、肺力学、胸部运动学、运动生理学。评价肺康复对心血管系统、肺力学、肌肉、运动能力和生活质量的影响。考虑实验室指标、合并症、肥胖、恶病质、戒烟等因素。结果：血糖、肾功能升高、白蛋白水平降低增加了发病风险。慢性阻塞性肺病、睡眠呼吸暂停、心力衰竭、肥胖和恶病质会影响预后。戒烟可减少术后并发症。控制呼吸技术、胸壁松动、训练都有良好的效果。心理社会支持和饮食是重要的。结论：实验室参数、肺功能、摄氧量和合并症支持危险分层。肺康复可以改善功能和生活质量。
Introduction: Besides the oncology and operative surgical technics, functional aspects influence the operability of lung cancer. Preoperative risk stratification, evaluation of postoperative complications needs to be considered.Aim: To review international literature and experiences of our institute.Method: We focused the literature of risk stratification of thoracic surgery. Lung function, lung mechanics, chest kinematics, exercise physiology were considered. Effectiveness of pulmonary rehabilitation for cardiovascular system, lung mechanics, muscles, exercise capacity and quality of life were evaluated. Laboratory parameters, comorbidities, obesity, cachexia, smoking cessation were considered.Results: Elevated blood sugar, kidney function, reduced albumin level increased the risk. COPD, sleep apnoea, heart failure, obesity and cachexia influences the outcome. Smoking cessation may reduce postoperative complications. Controlled breathing technics, chest wall mobilization, training have favourable effects. Psychosocial support and dietetics are important.Conclusions: Risk stratification is supported by laboratory parameters, lung function, oxygen uptake and comorbidities. Pulmonary rehabilitation can improve functionality and quality of life.