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首页> 外文期刊>The New England journal of medicine >Patients at high risk of death after lung-volume-reduction surgery.
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Patients at high risk of death after lung-volume-reduction surgery.

机译：减少肺体积手术后死亡风险高的患者。

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BACKGROUND: Lung-volume-reduction surgery is a proposed treatment for emphysema, but optimal selection criteria have not been defined. The National Emphysema Treatment Trial is a randomized, multicenter clinical trial comparing lung-volume-reduction surgery with medical treatment. METHODS: After evaluation and pulmonary rehabilitation, we randomly assigned patients to undergo lung-volume-reduction surgery or receive medical treatment. Outcomes were monitored by an independent data and safety monitoring board. RESULTS: A total of 1033 patients had been randomized by June 2001. For 69 patients who had a forced expiratory volume in one second (FEV1) that was no more than 20 percent of their predicted value and either a homogeneous distribution of emphysema on computed tomography or a carbon monoxide diffusing capacity that was no more than 20 percent of their predicted value, the 30-day mortality rate after surgery was 16 percent (95 percent confidence interval, 8.2 to 26.7 percent), as compared with a rate of 0 percent among 70 medically treated patients (P<0.001). Among these high-risk patients, the overall mortality rate was higher in surgical patients than medical patients (0.43 deaths per person-year vs. 0.11 deaths per person-year; relative risk, 3.9; 95 percent confidence interval, 1.9 to 9.0). As compared with medically treated patients, survivors of surgery had small improvements at six months in the maximal workload (P= 0.06), the distance walked in six minutes (P=0.03), and FEV1 (P<0.001), but a similar health-related quality of life. The results of the analysis of functional outcomes for all patients, which accounted for deaths and missing data, did not favor either treatment. CONCLUSIONS: Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV1 and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery.
机译：背景：肺减容术是肺气肿的一种提议治疗方法，但尚未确定最佳选择标准。国家肺气肿治疗试验是一项随机的，多中心的临床试验，将减少肺体积的手术与药物治疗进行了比较。方法：经过评估和肺康复后，我们随机分配患者进行肺减容手术或接受治疗。结果由独立的数据和安全监控委员会进行监控。结果：截止到2001年6月，共有1033例患者被随机分组​​。对于69例患者，其一秒钟内的强制呼气量（FEV1）不超过其预期值的20％，并且在计算机断层扫描中其气肿分布均匀或一氧化碳扩散能力不超过其预期值的20％，则手术后30天死亡率为16％（95％置信区间为8.2％至26.7％），而其中0％为70名药物治疗的患者（P <0.001）。在这些高风险患者中，手术患者的总死亡率高于内科患者（每人年0.43例死亡，每人年0.11例;相对危险度3.9; 95％置信区间1.9至9.0）。与药物治疗的患者相比，手术幸存者在六个月的最大工作量（P = 0.06），行走距离（六分钟）（P = 0.03）和FEV1（P <0.001）方面有较小改善，但健康状况相似相关的生活质量。所有患者的功能结局分析结果（包括死亡和数据丢失）均不支持任何一种治疗方法。结论：对于肺气肿的FEV1低，均质性肺气肿或一氧化碳扩散能力非常低的肺气肿患者，应谨慎使用肺减肺术。这些患者手术后死亡风险很高，也不太可能从手术中受益。

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