Mechanism of Short-term Improvement in Exercise Tolerance After Lung Volume Reduction Surgery for Severe Emphysema
Yukinori Matsuzawa Keishi Kubo Keisaku Fujimoto Seiichiro Eda Masayuki Hanaoka Yoshitaka Yamazaki Toshio Kobayashi Morie Sekiguchi Takeshi Yamanda* Masayuki Haniuda*
First Department of Internal Medicine, *Second Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-0802 Japan
To investigate the mechanism of short-term improvement in exercise tolerance after lung volume reduction surgery (LVRS) for severe emphysema, we performed six-minute walk tests and pulmonary-function tests, and studied their correlation before and 3-to-5 months after LVRS in 7 patients with severe emphysema who underwent bilateral lung reduction via median sternotomy. Results of the tests showed a 59% increase in the 1-second forced expiratory volume (FEV1), a 25% reduction in the functional residual capacity (FRC), a 49% increase in the maximum voluntary ventilation (MVV), and a 20% increase in the distance walked in 6 minutes (6MD). The degree of improvement in 6 MD correlated significantly with the degree of improvement in FEV1 (r=0.97, p< 0.01), in FRC (r=0.86, p< 0.05), and in MVV (r=0.87, p< 0.05), and did not correlate with the degree of improvement in pulmonary gas exchange. These results support the hypothesis that an increase in lung elastic recoil after targeted emphysematous resection reduces airflow limitation, and thus leads to a short-term improvement in exercise tolerance after LVRS.
Chronic pulmonary emphysema Lung volume reduction surgery Exercise tolerance 6-minute walk test Pulmonary function test
Received 平成9年6月2日
JJRS, 36(4): 323-329, 1998