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Association between Pulmonary Function and Stair-Climbing Test Results after Lung Resection: A Pilot 时间:2018-09-14 10:00 来源:未知作者:admin 点击: 次 Abstract:Background. The stair-climbing test was used to assess the exercise capacity before lung resection in subjects with lung cancer. However, few studies have systematically evaluated the role of this exercise methodology as a postoperative test. The aim of the present study was to assess whether the stair-climbing test findings reflect the postoperative decrease in pulmonary function. Methods. Twenty subjects with non-small-cell lung cancer who underwent lung resection were enrolled in the study. Perioperative functional evaluation comprised the pulmonary function test, stair-climbing test, and 6-min walk distance test (6MWD). A correlation analysis was performed between the postoperative percentages of pulmonary function with respect to preoperative values and the exercise capacity. Results. No correlation was noted between the percentage changes in pulmonary function and those in 6MWD. However, there was a significant correlation between the percentage changes in forced expiratory volume in 1 s and those in the altitude reached in the stair-climbing test (, ) and between the percentage changes in carbon monoxide lung diffusion capacity and those in the altitude (, ). Conclusions. The stair-climbing test findings might be effective at detecting changes in exercise capacity induced by postoperative decrease in pulmonary function.
1. Introduction
In subjects with lung cancer, lung resection causes the lung volume to decrease, leading to a reduction in the ventilation volume and size of the pulmonary vascular bed [1]. These changes disturb pulmonary function. Two studies [1, 2] have reported that percent vital capacity (%VC), percent forced expiratory volume in 1 s (%FEV1.0), and percent carbon monoxide lung diffusion capacity (%DLCO) decrease by approximately 20%–30% at 1 month after surgery. These changes in pulmonary function can lead to a postoperative reduction in exercise capacity. Recently, various reports [3–6] have demonstrated that exercise training after resection confers an increase in exercise capacity in this population. In these reports, exercise capacity was evaluated using the 6-min walk test [7]. However, Nomori et al. [8] reported no significant correlations between the postoperative decrease in pulmonary function and that in 6-min walk distance (6MWD). Thus, discrepant findings have been published regarding the association between 6MWD findings and lung resection outcomes.
According to the recommendation of the European Respiratory Society and the clinical guidelines of European Society of Thoracic Surgery [9], the stair-climbing test should be used as a first-line screening test to optimize perioperative management. The stair-climbing test has been conventionally used by thoracic surgeons to select patients prior to surgery [10, 11], and Bolton et al. [10] reported a strong relationship between the altitude reached in the stair-climbing test and pulmonary function before lung resection. In our previous study [12], the stair-climbing test results showed a significant deterioration at one month after lung resection; however, a significant change in the 6MWD was not observed. Therefore, the stair-climbing test, as compared to the 6MWD, might be more sensitive at detecting changes in cardiorespiratory fitness induced by lung resection. However, few studies have reported the relationship between the altitudes reached in the stair-climbing test and pulmonary function after lung resection. The aim of the present study was to assess whether the stair-climbing test findings adequately reflect the postoperative decrease in pulmonary function compared with the 6MWD findings.
2. Methods
2.1. Subjects
Twenty-three subjects with non-small cell lung cancer who underwent lung resection at our hospital from January to October 2014 were enrolled in the study after obtaining their informed consent. Three subjects were excluded from the study due to postoperative cardiopulmonary complications. The following complications were considered [11]: respiratory failure requiring mechanical ventilation for >48 h, pneumonia, atelectasis requiring bronchoscopy, pulmonary edema, pulmonary embolism, myocardial infarction, hemodynamically unstable arrhythmia requiring medical treatment, cardiac failure, and death. The remaining 20 subjects (12 men and 8 women) formed the database for analysis. This study protocol was approved by the Ethics Committee of the Kansai Electric Power Hospital (#2639).