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Vol. 34. Issue 10.
Pages 473-478 (November 1998)
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Vol. 34. Issue 10.
Pages 473-478 (November 1998)
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Predicción de capacidad de esfuerzo tras resección pulmonar en pacientes con limitación crónica al flujo aéreo
Predicting exercise capacity after lung resection in patients with chronic airflow limitation
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L. Puente-Maestu*, J.M. Ruíz de Oña, J.L. Rodríguez-Hermosa, A. Santa-Cruz Siminiani, E. Tatay, J.M. Cubillo
Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid
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Para analizar la utilidad de una forma de estimar la captación pico de oxígeno postoperatoria basada en la función ventilatoria perdida tras resección pulmonar (V.O2pico-PPO) y establecer las razones fisiológicas subyacentes a la relaciön entre ésta y el valor medido postoperatorio (V.O2pico-PO), estudiamos a 29 pacientes (26 varones) de 60 años (DE, 9), con limitación crónica al flujo aéreo, FEV1 = 66% (DE, 13), sometidos a lobectomía o mayor resección pulmonar por cáncer de pulmón. Los pacientes se dividieron en 2 grupos: aquellos cuya ergometría postoperatoria se consideró limitada por el agotamiento de la reserva ventilatoria (LV) y los demás (NLV). Una semana antes de la cirugía se evaluó la disnea y se realizaron pruebas de función ventilatoria, ergometría en tapiz rodante y gammagrafia de perfusión para estimar la función postoperatoria. Las mismas mediciones se repitieron aproximadamente 5 meses después de la cirugía, salvo la gammagrafía. La diferencia media entre V.O2pico-PPO y V.O2pico-PO fue de –0,034 (IC: 0,293 a 0,348) l/min-1 y el coeficiente de correlación intraclase de 0,76. La correlación entre V.O2pico-PPO y la disnea postoperatoria fue de –0,72. La correlación entre V.O2pico-PPO y V.O2pico-PO fue de 0,86 (EE, 0,1) (0,89 [0,13] para los LV [n = 14] y 0,85 [0,16] para los NLV [n = 15]). Las correlaciones tras ajustar para la V.O2pico preoperatoria fueron 0,73 (0,2) en los LV y 0,35 (0,27) en los NLV. Concluimos que el V.O2pico-PPO es un estimador válido pero sólo moderadamente preciso del V.O2pico-PO. Únicamente en los pacientes con LV existe una verdadera relación entre la reducción del V.O2pico y la pérdida de función ventilatoria.

Palabras clave:
Prueha de esfuerzo
Resección pulmonar
Captación de oxígeno
Capacidad de esfuerzo
Disnea

To assess the usefulness of a method for predicting postoperative peak oxygen uptake based on lost lung function after lung resection (V.O2peak-PPO) and to establish the underlying physiological foundation for the relation between V.O2peak-PPO and the measured postoperative value (V.O2peak-PO), we studied 29 patients (26 men) [age 60 (SD9)] with chronic airflow limitation [FEV1 = 66 (SD13) %] undergoing lobectomy or major pulmonary resection to treat lung cancer. The patients were assigned to groups according to whether postoperative exercise tolerance was considered to be limited by exhaustion of ventilatory reserve (LV) or not (NLV). Data to estimate postoperative pulmonary function was obtained one week before surgery: patients performed pulmonary function tests and exercise tests on a treadmill; dyspnea was also evaluated and perfusion scintigraphs were obtained. Pulmonary function, exercise tolerance and dyspnea were evaluated again approximately five months after surgery. The mean difference between V.O2peak-PPO and V.O2peak-PO was –0.034 (CI 0.293 to –0.348) l.min-1 and the between-group correlation coefficient was 0.76. The correlation between V.O2peak-PPO and V.O2peak-PO was 0.86 (SE 0.1) [0.89 (SE 0.13) for LV (n=14) patients and 0.85 (SE 0.16) for NLV (n=15) patients]. The correlations after adjusting for preoperative V.O2peak-PPO were 0.73 (SE 0.2) and 0.35 (SE 0.27) for LV and NLV patients, respectively. We conclude that V.O2peak-PPO provides a valid but only moderately precise estimate of V.O2peak-PO. Only in LV patients is there a true relation between a decrease in V.O2peak and loss of lung function.

Key words:
Exercise testing
Lung resection
Oxygen uptake
Exercise tolerance
Dyspnea
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