Dokument: Korrelation funktioneller Lungenkapazität und präoperativer Lungenfunktion bei Patient:innen, die sich nicht-kardialen Operationen mit erhöhtem Risiko unterziehen : METS-Spiros : Spirometire-Substudie zur internationalen Multizenter-Studie MET-REPAIR
| Titel: | Korrelation funktioneller Lungenkapazität und präoperativer Lungenfunktion bei Patient:innen, die sich nicht-kardialen Operationen mit erhöhtem Risiko unterziehen : METS-Spiros : Spirometire-Substudie zur internationalen Multizenter-Studie MET-REPAIR | |||||||
| Weiterer Titel: | Correlation of functional lung capacity and preoperative lung function in patients undergoing high risk non-cardiac surgery | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=69759 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20250630-075251-3 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Sawitzki, Leander [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Meyer, Tanja [Gutachter] Prof. Dr. phil. Pollok, Bettina [Gutachter] | |||||||
| Stichwörter: | Lungenfunktion, präoperative Lungenfunktion, metabolisch Äquivalente, funktionelle Kapazität, Met-Spiros | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Zusammenfassung
Metabolische Äquivalente (METs) werden verwendet, um den Energieverbrauch ver-schiedener körperlicher Aktivitäten vergleichen zu können. In der Anästhesie wird durch METs die Belastbarkeit von Patient:innen vor Operationen eingeschätzt. Die internationale Multizenter Studie “MET-REPAIR“ beschäftigte sich mit der Frage, ob mithilfe von METs, durch präoperative Fragebögen von Patient:innen ermittelt, das Auftreten von kardiovaskulären Komplikationen und Letalität bei nicht-herzchirurgischen Eingriffen abgeschätzt werden kann. Die vorliegende Arbeit erhob als sogenannte Substudie zusätzlich präoperativ die spirometrische Lungenfunktion. In Studien sind Zusammenhänge zwischen der Lungenfunktion, gemessen als Einse-kundenkapazität (FEV1), und der Leistungsfähigkeit von Patient:innen beschrieben. Meist erfolgten sie an Patient:innen mit Lungenerkrankungen und zeigten, dass die körperliche Belastbarkeit mit der FEV1 korreliert. Auch bei gesunden Personen korre-liert die FEV1 signifikant mit stark energiebeanspruchenden Aktivitäten. Nicht be-kannt ist, ob bei Patient:innen, die sich einer nicht-herzchirurgischen elektiven Opera-tion unterziehen, ein Zusammenhang zwischen einer präoperativ reduzierten Lungen-funktion und der körperlichen Belastbarkeit, gemessen in METs, besteht. Im Rahmen der hier vorliegenden Studie wurde untersucht, inwieweit die körperliche Belastbarkeit und die ermittelten METs mit der präoperativen Lungenfunktion korrelieren. Nach aktueller Leitlinie gilt der Grenzwert von < 4 METs als Indikator für ein erhöhtes Ri-siko für postoperative Komplikationen. Als weiterführende Fragestellung wurde unter-sucht, ob durch die präoperative Lungenfunktion eine Trennschärfe bezüglich des Cutt-off-Wertes von METs > 4 besteht. In der Studie wurden 208 Patient:innen eingeschlossen und bei 207 spirometrische Daten erhoben. 121 Personen waren männlich (59 %), 86 weiblich (41 %), das Alter betrug im Median 72 Jahre. Die Auswertung der Spirometriedaten erfolgte nach Al-tersgruppen (< 65 Jahren, ≥ 65 Jahren) und nach Geschlecht. Bestimmt wurden die FEV1, FVC, FEV1/FVC, FEV1 % und FVC % des Sollwertes. Die absolute FVC war in der Gruppe < 65 Jahre signifikant höher, die FEV1/FVC war in der Gruppe > 65 Jahren signifikant höher, die FEV1 und FVC waren bei Männern signifikant höher als bei Frauen, die FEV1 % des Sollwertes und FVC % des Sollwertes waren bei Frauen signi-fikant höher. In der Analyse der MET-Repair-Daten zur körperlichen Belastbarkeit mit der Lungenfunktion wurde keine signifikante Korrelation festgestellt. Eine ROC-Analyse ergab ebenfalls keinen Hinweis auf einen direkten Zusammenhang der FEV1 mit dem Grenzwert METs > 4. Abschließend konnte keine Korrelation der Lungen-funktion, gemessen als FEV1 und FVC, und der körperlichen Belastbarkeit, gemessen in METs, nachgewiesen werden. Somit ergibt sich nach diesen Ergebnissen keine Empfehlung zur präoperativen Lun-genfunktionsmessung vor einer nicht-herzchirurgischen elektiven Operation.Abstract Metabolic equivalents (METs) are used to compare the energy consumption of differ-ent physical activities. In anesthesia, METs are used to assess the physical capacity of patients before operations. The international multicenter study “MET-REPAIR” dealt with the question of whether METs, determined by preoperative questionnaires of pa-tients, can be used to estimate the occurrence of cardiovascular complications and mortality in non-cardiac surgery. As a so-called sub-study, the present study also rec-orded spirometric lung function preoperatively. Studies have described correlations between lung function, measured as one-second capacity (FEV1), and the physical capacity of patients. Most of these studies were car-ried out on patients with lung diseases and showed that physical capacity correlates with FEV1. FEV1 also correlates significantly with high-energy activities in healthy individuals. It is not known whether there is a correlation between preoperatively re-duced lung function and physical capacity, measured in METs, in patients undergoing non-cardiac elective surgery. The present study investigated the extent to which physi-cal capacity and the METs determined correlate with preoperative lung function. Ac-cording to current guidelines, a threshold value of < 4 METs is considered an indicator of an increased risk of postoperative complications. As a further question, it was in-vestigated whether the preoperative lung function provides a discriminatory power with regard to the cut-off value of METs > 4. The study included 208 patients and spirometric data was collected from 207. 121 people were male (59%), 86 female (41%), the median age was 72 years. The spirome-try data was analyzed according to age groups (< 65 years, ≥ 65 years) and gender. The FEV1, FVC, FEV1/FVC, FEV1 % and FVC % of the expected value were determined. The absolute FVC was significantly higher in the group < 65 years, the FEV1/FVC was significantly higher in the group > 65 years, the FEV1 and FVC were significantly higher in men than in women, the FEV1% of the expected value and FVC% of the ex-pected value were significantly higher in women. In the analysis of MET-repair data on physical capacity with lung function, no significant correlation was found. A ROC analysis also showed no evidence of a direct correlation between FEV1 and the METs > 4 threshold. Finally, no correlation between lung function, measured as FEV1 and FVC, and physical capacity, measured in METs, could be demonstrated. Thus, these results do not provide a recommendation for preoperative lung function measurement prior to elective non-cardiac surgery. | |||||||
| Quelle: | Literatur- und Quellenverzeichnis
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| Dokument erstellt am: | 30.06.2025 | |||||||
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