6分钟步行试验在肺叶切除术患者术前评估中的应用

doi:10.3969/j.issn.1006-9771.2022.02.016

Abstract

Abstract:

Objective To analyze the feasibility of six-minute walk test (6MWT) before pulmonary lobectomy and prediction for postoperative outcome. Methods A total of 580 patients who were hospitalized in the department of lung surgery from May, 2017 to May, 2019 were reviewed, and 274 eligible patients were selected, who underwent first surgery and the surgical method was pulmonary lobectomy. They were divided into two groups based on the results of 6MWT before operation. The cut-off value of six-minute walk distance (6MWD) was obtained by receiver operating characteristic curve (ROC) area under curve (AUC). The postoperative outcome and the occurrence of cardiopulmonary complications in the two groups were analyzed. Results Compared to patients with 6MWD > 449 meters, the age was significantly older (P < 0.001), the forced expiratory volume in the first second (FEV₁) was poor in patients with 6MWD ≤ 449 meters (P < 0.05), and other factors such as surgical resection site, pathological stage, gender, etc., were not significantly different (P > 0.05). The incidence of postoperative cardiopulmonary complications was significantly higher (OR = 2.672, 95%CI 1.488 to 4.798, P = 0.002), and the postoperative extubation time and hospital stay was longer in patients with 6MWD ≤ 449 meters than in patients with 6MWD > 449 meters (P < 0.05). 6MWD ≤ 449 meters was an independent risk factor for postoperative cardiopulmonary complications (OR = 2.395, 95%CI 1.299 to 4.415, P = 0.005). Conclusion As a simple function test, 6MWT can be routinely used to assess the physiological function of patients undergoing pulmonary lobectomy. Patients with 6MWD ≤ 449 meters may be in higher risks of postoperative cardiopulmonary complications.

Key words: six-minute walk test, pulmonary lobectomy, preoperative evaluation

CLC Number:

R734.2

WANG Longping,YANG Xuening,ZENG Bin,XU Guangqing. Application of six-minute walk test in preoperative evaluation of patients undergoing pulmonary lobectomy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 242-248.

Figures/Tables 4

References 31

[1]	COLICE G L, SHAFAZAND S, GRIFFIN J P, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition)[J]. Chest, 2007, 132(3 Suppl): 161S-77S. doi: 10.1378/chest.07-1359
[2]	CHARLOUX A, BRUNELLI A, BOLLIGER C T, et al. Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS)[J]. Interact Cardiovasc Thorac Surg, 2009, 9(6): 925-931. doi: 10.1510/icvts.2009.211219
[3]	BENNELL K, DOBSON F, HINMAN R. Measures of physical performance assessments: Self-Paced Walk Test (SPWT), Stair Climb Test (SCT), Six-Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task[J]. Arthritis Care Res (Hoboken), 2011, 63(Suppl 11): S350-S370. doi: 10.1002/acr.v63.11s
[4]	HONG S H, YANG H I, KIM D I, et al. Validation of Submaximal Step Tests and the 6-min Walk Test for predicting maximal oxygen consumption in young and healthy participants[J]. Int J Environ Res Public Health, 2019, 16(23): 4858. doi: 10.3390/ijerph16234858
[5]	范超群, 徐凯, 聂明剑, 等. 心肺耐力的科学测评:心肺运动试验与6 min二级台阶试验的比较[J]. 中国组织工程研究, 2019, 23: 3686-3691.
	FAN C Q, XU K, NIE M J, et al. Evaluation of the cardiopulmonary endurance: cardiopulmonary exercise test versus 6-minute two-step test[J]. Zhongguo Zuzhi Gongcheng Yanjiu, 2019, 23(23): 3686-3691.
[6]	马明, 林强, 秦洪云. 六分钟步行试验与摄氧量的相关性研究[J]. 中国组织工程研究与临床康复, 2009, 13(50): 9909-9912.
	MA M, LIN Q, QIN H Y. Correlation between 6-minute walking test and oxygen uptake[J]. J Clin Rehabil Tissue Engineer Res, 2009, 13(50): 9909-9912.
[7]	BENZO R P, SCIURBA F C. Oxygen consumption, shuttle walking test and the evaluation of lung resection[J]. Respiration, 2010, 80(1): 19-23. doi: 10.1159/000235543
[8]	DEKA P, POZEHL B J, PATHAK D, et al. Predicting maximal oxygen uptake from the 6 min walk test in patients with heart failure[J]. ESC Heart Fail, 2021, 8(1): 47-54.
[9]	李娜, 邱晨, 魏永丽. 六分钟步行试验与慢性阻塞性肺疾病患者肺功能的关系[J]. 中国组织工程研究与临床康复, 2008, 11: 2116-2119.
	LI N, QIU C, WEI Y L. Role of 6-minute walk test in chronic obstructive pulmonary diseases[J]. J Clin Rehabil Tissue Engineer Res, 2008, 12(11): 2116-2119.
[10]	齐喜玲, 许海燕, 于子凯, 等. 六分钟步行试验在经导管主动脉瓣置换术后心脏康复中的指导价值[J]. 中华老年心脑血管病杂志, 2019, 21(7): 695-698.
	QI X L, XU H Y, YU Z K, et al. The guiding value of the six-minute walk test in cardiac rehabilitation after transcatheter aortic valve replacement[J]. Chin J Geriatr Heart Brain Vessel Dis, 2019, 21(7): 695-698.
[11]	于进. 6分钟步行训练对COPD患者呼吸困难的影响[J]. 中国康复理论与实践, 2003, 9(9): 52-53.
	YU J. 6 minute walk exercise improves dypnea of patients with chronic obstructive pulmonary disease[J]. Chin J Rehabil Theory Pract, 2003, 9(9): 52-53.
[12]	BONNEVIE T, GRAVIER F E, LEBOULLENGER M, et al. Six-minute Stepper Test to set pulmonary rehabilitation intensity in patients with COPD: a retrospective study[J]. COPD, 2017, 14(3): 293-297. doi: 10.1080/15412555.2017.1303040
[13]	MARINHO R S, JÜRGENSEN S P, ARCURI J F, et al. Reliability and validity of six-minute step test in patients with heart failure[J]. Braz J Med Biol Res, 2021, 54(10): e10514. doi: 10.1590/1414-431x2020e10514
[14]	高珂, 赖玉田, 黄健, 等. 非小细胞肺癌患者术前肺康复训练前后血清肺表面活性蛋白D(SP-D)改变与术后肺部并发症相关性的随机对照试验[J]. 中国胸心血管外科临床杂志, 2017, 24(5): 330-337.
	GAO K, LAI Y T, HUANG J, et al. Preoperative pulmonary rehabilitation training to reduce the serum surfactant protein D (SP-D) level and postoperative pulmonary complications of lung cancer surgery with high risk factors: a randomized controlled trial[J]. Chin J Clin Thoracic Cardiov Surg, 2017, 24(5): 330-337.
[15]	LAI Y, SU J, WANG M, et al. [Classification and risk-factor analysis of postoperative cardio-pulmonary complications after lobectomy in patients with stage I non-small cell lung cancer][J]. [in Chinese] Zhongguo Fei Ai Za Zhi, 2016, 19(5): 286-292.
[16]	SEDER C W, SALATI M, KOZOWER B D, et al. Variation in pulmonary resection practices between the Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases[J]. Ann Thorac Surg, 2016, 101(6): 2077-2084. doi: 10.1016/j.athoracsur.2015.12.073
[17]	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test[J]. Am J Respir Crit Care Med, 2002, 166(1): 111-117. doi: 10.1164/ajrccm.166.1.at1102
[18]	MAININI C, REBELO P F, BARDELLI R, et al. Perioperative physical exercise interventions for patients undergoing lung cancer surgery: what is the evidence[J]. SAGE Open Med, 2016, 4: 2050312116673855.
[19]	HOLDEN D A, RICE T W, STELMACH K, et al. Exercise testing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection[J]. Chest, 1992, 102(6): 1774-1779. doi: 10.1378/chest.102.6.1774
[20]	BRUNELLI A, POMPILI C, SALATI M. Low-technology exercise test in the preoperative evaluation of lung resection candidates[J]. Monaldi Arch Chest Dis, 2010, 73(2): 72-78.
[21]	BOUJIBAR F, GILLIBERT A, GRAVIER F E, et al. Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis[J]. Thorax, 2020, 75(9): 791-797. doi: 10.1136/thoraxjnl-2019-214019
[22]	OLSEN G N, BOLTON J W, WEIMAN D S, et al. Stair climbing as an exercise test to predict the postoperative complications of lung resection. Two years' experience[J]. Chest, 1991, 99(3): 587-590. doi: 10.1378/chest.99.3.587
[23]	WIN T, JACKSON A, GROVES A M, et al. Relationship of shuttle walk test and lung cancer surgical outcome[J]. Eur J Cardiothorac Surg, 2004, 26(6): 1216-1219. doi: 10.1016/j.ejcts.2004.07.036
[24]	LEWIS M E, NEWALL C, TOWNEND J N, et al. Incremental shuttle walk test in the assessment of patients for heart transplantation[J]. Heart, 2001, 86(2): 183-187.
[25]	NAKAGAWA T, CHIBA N, SAITO M, et al. Clinical relevance of decreased oxygen saturation during 6-min walk test in preoperative physiologic assessment for lung cancer surgery[J]. Gen Thorac Cardiovasc Surg, 2014, 62(10): 620-626. doi: 10.1007/s11748-014-0413-y
[26]	BRUNELLI A, KIM A W, BERGER K I, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2013, 143(5 Suppl): e166S-e190S. doi: 10.1378/chest.12-2395
[27]	MARJANSKI T, WNUK D, BOSAKOWSKI D, et al. Patients who do not reach a distance of 500 m during the 6-min walk test have an increased risk of postoperative complications and prolonged hospital stay after lobectomy[J]. Eur J Cardiothorac Surg, 2015, 47(5): e213-e219. doi: 10.1093/ejcts/ezv049
[28]	IRIE M, NAKANISHI R, YASUDA M, et al. Risk factors for short-term outcomes after thoracoscopic lobectomy for lung cancer[J]. Eur Respir J, 2016, 48(2): 495-503. doi: 10.1183/13993003.01939-2015
[29]	HAMADA K, IRIE M, FUJINO Y, et al. Prognostic value of preoperative exercise capacity in patients undergoing thoracoscopic lobectomy for non-small cell lung cancer[J]. Lung Cancer, 2019, 128: 47-52. doi: 10.1016/j.lungcan.2018.12.013
[30]	LEE H, KIM H K, KANG D, et al. Prognostic value of 6-min Walk Test to predict postoperative cardiopulmonary complications in patients with non-small cell lung cancer[J]. Chest, 2020, 157(6): 1665-1673. doi: 10.1016/j.chest.2019.12.039
[31]	CHEN K, YANG F, JIANG G, et al. Development and validation of a clinical prediction model for N2 lymph node metastasis in non-small cell lung cancer[J]. Ann Thorac Surg, 2013, 96(5): 1761-1768. doi: 10.1016/j.athoracsur.2013.06.038

项目	诊断标准
心律失常	需要药物干预或心内科会诊
肺部感染	①痰或胸水中查到病原菌; ②患者出现白细胞计数升高(> 12×10⁹ /L)和/或体温> 38°,持续3 d或经抗生素处理后明显下降; ③术后增加或调整抗生素后,症状或体征减轻或消失,白细胞计数明显下降,或者影像学显示浸润灶相应缩小
肺不张	①影像学显示肺不张; ②有呼吸困难表现且在不吸氧情况下血氧饱和度下降至90%以下
皮下气肿	①超过手术侧胸壁的皮下积气; ②皮下积气≥ 15 d; ③需要皮肤切口引流
中到大量胸腔积液	①引流时间≥ 15 d; ②需要再次置管
持续性肺漏气	①持续时间≥ 15 d; ②需要再次置管引流; ③持续负压吸引时间≥ 3 d; ④需手术治疗
乳糜胸	①手术后非血性引流液24 h引流量≥ 500 ml且持续时间≥ 3 d; ②禁食治疗≥ 5 d; ③需要开胸处理
呼吸衰竭	①需要行气管插管; ②需要呼吸机辅助通气; ③需转重症监护室治疗
咯血	①药物治疗无效且持续时间≥ 3 d; ②咳血量1次≥ 30 ml; ③需手术治疗

项目	6MWD > 449 m组(n = 183)	6MWD ≤ 449 m组(n = 91)	χ²/t值	P值
年龄/岁	57.29±10.16	63.1±9.24	-4.592	< 0.001
性别/n			0.434	0.510
男	105	56
女	78	35
FEV₁/L	2.40±0.63	2.22±0.49	2.526	0.012
FEV1/%预测值	90.25±17.56	87.55±16.29	1.225	0.222
FVC/L	2.94±0.75	2.80±0.63	1.595	0.112
FVC/%预测值	96.78±15.54	95.12±15.13	0.841	0.401
6MWD/m	532.25±62.90	389.24±57.02	18.271	< 0.001
切除部位/n
右上肺	58	24	0.820	0.365
右中肺	30	9	2.106	0.147
右下肺	28	14	0.000	0.985
左上肺	39	23	0.545	0.460
左下肺	28	21	2.503	0.114
病理分期/n
ⅠA	55	35	1.947	0.163
ⅠB	46	23	0.001	0.980
ⅡA	31	15	0.009	0.924
ⅡB	33	14	0.300	0.548
ⅢA	18	4	2.436	0.119
ⅢB	0	0

项目	6MWD > 449 m组(n = 183)	6MWD ≤ 449 m组(n = 91)	OR(95%CI)	P值
心肺相关并发症/n	30	30	2.672(1.488~4.798)	0.002
心律失常	3	2	1.348(0.221~8.215)	> 0.999
肺部感染	11	8	1.507(0.584~3.888)	0.394
肺不张	4	6	3.159(0.868~11.489)	0.088
皮下气肿	5	3	1.214(0.284~5.194)	> 0.999
中到大量胸腔积液	3	5	3.488(0.815~14.934)	0.160
持续性肺漏气	4	5	2.602(0.681~9.933)	0.277
乳糜胸	0	1	-	-
呼吸衰竭	0	0	-	-
咯血	0	0	-	-
术后拔管时间/d	1.97±1.95	2.46±1.85		0.045
术后住院时间/d	4.97±2.34	5.36±2.41		0.199
总住院时间/d	10.92±4.72	12.45±5.34		0.016

项目	OR(95%CI)	P值
年龄	0.999(0.967~1.032)	0.963
FEV₁	0.702(0.401~1.231)	0.217
6MWD ≤ 449 m	2.395(1.299~4.415)	0.005

Application of six-minute walk test in preoperative evaluation of patients undergoing pulmonary lobectomy

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