Else A M D Ter Haar, Dirk-Jan Slebos, Jorine E Hartman
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引用次数: 0
Abstract
Background: Lung volume reduction, either surgical or bronchoscopic, is an effective therapeutic strategy that improves pulmonary function, quality of life and exercise capacity in patients with advanced emphysema. The aim of this review was to evaluate the extrapulmonary effects of this treatment.
Methods: PubMed, Embase and Web of Science were searched until 19 August 2024. The extrapulmonary effects were classified into nine distinct domains. Studies that reported outcomes related to one of the predefined extrapulmonary domains with a follow-up duration of at least 1 month were eligible for inclusion. A descriptive summary of the effects from all studies was compiled.
Results: A total of 85 articles were included. The majority of studies were conducted in patients who underwent lung volume reduction surgery (74%). The greatest improvements were found in respiratory muscle strength, ventilatory drive, diaphragm morphology and body mass index. While the effects were less pronounced, beneficial outcomes were also observed for body composition, inflammation, oxidative stress, anxiety, depression and bone mineral density. The overall treatment effect of lung volume reduction on cardiac function and pulmonary arterial pressure was inconclusive; however, there is no evidence to suggest any significant deterioration. For the extrapulmonary domains of cognition, sleep and peripheral muscle function, evidence is currently insufficient to determine whether lung volume reduction has any impact.
Conclusion: Lung volume reduction treatment has multiple beneficial extrapulmonary effects in patients with severe emphysema and lung hyperinflation. These findings support the use of lung volume reduction as a treatment for this patient population.
背景：手术或支气管镜下肺减容是改善晚期肺气肿患者肺功能、生活质量和运动能力的有效治疗策略。本综述的目的是评估这种治疗的肺外效果。方法：检索至2024年8月19日的PubMed、Embase和Web of Science。肺外效应分为九个不同的领域。报告的结果与预定的肺外域之一相关且随访时间至少为1个月的研究符合纳入条件。对所有研究的效果进行了描述性总结。结果：共纳入85篇文献。大多数研究是在接受肺减容手术的患者中进行的（74%）。最大的改善是在呼吸肌力量，通气驱动，隔膜形态和体重指数。虽然效果不太明显，但在身体成分、炎症、氧化应激、焦虑、抑郁和骨密度方面也观察到有益的结果。肺减容对心功能和肺动脉压的整体治疗效果尚无定论；然而，没有证据表明有任何明显的恶化。对于认知、睡眠和外周肌肉功能等肺外领域，目前还没有足够的证据来确定肺体积减少是否有任何影响。结论：肺减容治疗对严重肺气肿伴肺恶性膨胀患者有多种有益的肺外作用。这些发现支持将肺减容术作为这类患者的一种治疗方法。
期刊介绍：
The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.
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