肥胖减重术后肺功能的变化及可逆性研究

Improvement of pulmonary function in obese patients after bariatric surgery

关键词:  肥胖  肺功能  减重手术

Key words:  obesity  pulmonary function  bariatric surgery

摘要:

目的探讨肥胖患者行减重手术1年后肺功能的变化及减重疗效与肺功能改善之间的相关性，并关注减重疗效稳定后肺功能的可逆性。方法筛选纳入2019年1月—2021年12月在同济大学附属第十人民医院行减重手术的肥胖患者51例，配对t检验或Wilcoxon配对符号秩检验比较减重前后患者的肺功能通气及换气指标。Spearman或Pearson相关性分析判定ΔBMI与各指标改善量之间的相关性。独立样本t检验或两独立样本的Mann-Whitney U检验比较减重术后1年肥胖患者与健康人群肺功能通气及换气指标。结果减重手术后肺活量、补呼气量、肺总量、功能残气量、残气量、一秒量、一秒率、呼气峰流量、最大呼气中期流量、呼气75%流量、呼气50%流量、呼气25%流量、一氧化碳弥散量（实测值及实测值/预计值）较术前均明显提高（P<0.05），深吸气量显著下降（P<0.05），差异有统计学意义。BMI下降与呼气25%流量、残气量及功能残气量的下降呈中等程度负相关（P<0.05）。减重手术1年后，与健康对照组相比，肺活量、补呼气量、用力肺活量、一秒量、最大呼气中期流量、呼气25%流量、功能残气量、残气量及一氧化碳弥散量的实测值/预计值更佳（P<0.05），峰流量%较健康对照组下降（P<0.05），差异有统计学意义。深吸气量%、一秒率、呼气75%流量%、呼气50%流量%、肺总量%与健康组无差异。结论减重手术后，患者肥胖程度减轻，肺通气功能和换气功能改善明显。肥胖引起的肺功能变化具有高度可逆性，积极减重，患者肺功能可明显恢复。

Abstract:

ObjectiveTo investigate the changes of pulmonary function in obese patients after bariatric surgery. MethodsFifty-one obese patients who underwent bariatric surgery in Shanghai Tenth People’s Hospital from January 2019 to December 2021 were enrolled in the study. The pulmonary function indexes VC, IC, ERV, RV, FRC, TLC, FEV1, FVC, FEV1/FVC, MEF75, MEF50, MEF25, MMEF, PEF and DLCO of patients before and after surgery were compared by paired T test or Wilcoxon matched pair sign rank test. Spearman or Pearson correlation analysis was used to determine the correlation between ΔBMI and the improvement of lung function indexes. The VC%, IC%, ERV%, RV%, FRC%, TLC%, FEV1%, FVC%, MEF75%, MEF50%, MEF25%, MMEF%, PEF%, DLCO% were compared between healthy subjects and obese patients one year after surgery by Mann-Whitney U test. ResultsThe pulmonary indexes VC, ERV, TLC, FRC, RV, FVC, FEV1, FEV1/FVC, PEF, MEF75, MEF50, MEF25, MMEF, DLCO after bariatric surgery were significantly increased（all P<0.05), and IC was significantly decreased（P<0.05) compared with those before surgery. The decrease of BMI was negatively correlated with the decrease of MEF25, RV and FRC (P<0.05). One year after weight loss surgery, VC%, ERV%, FVC%, FEV1%, MEF25%, MMEF%, FRC%, RV%, DLCO% of obese patients were significantly increased（P<0.05), and PEF% decreased compared with healthy controls（P<0.05); while there were no significant differences in IC%, FEV1/FVC%, MEF75%, MEF50%, TLC% between obese patients and healthy subjects. ConclusionAfter bariatric surgery, the degree of obesity in patients is reduced, pulmonary ventilation function and diffusion function are improved significantly. Changes in pulmonary function caused by obesity are highly reversible, which can be significantly recovered by active weight loss.