Präoperative Lungenfunktionsanalyse und kardiorespiratorische Risikoabschätzung, aktueller Standard

Zusammenfassung

Ziel der präoperativen Lungenfunktionsanalyse und kardiologischen Funktionsdiagnostik ist es, Patienten mit einem erhöhten Komplikationsrisiko zu identifizieren und über Behandlungsmöglichkeiten und Risiken bestmöglich aufzuklären, sodass eine fundierte Therapieentscheidung getroffen werden kann. Die Identifikation von Patienten mit erhöhtem periinterventionellen Risiko durch die präoperative physiologische Diagnostik bildet auch die Grundlage für weitere Entwicklungen und Verbesserungen von Interventionen und Interventionstechniken, um das Komplikationsrisiko insgesamt reduzieren zu können. Die Erhebung einer ausführlichen Anamnese, eine eingehende körperliche Untersuchung sowie die Diagnostik mittels EKG und Spirometrie können erste Hinweise für das Vorliegen relevanter Komorbiditäten liefern. Bei elektiven Eingriffen muss präoperativ eine differenzierte Bewertung der Komorbiditäten erfolgen, da die Assoziation von zunehmendem Alter und operativer Letalität nicht auf das Alter allein, sondern auf das Spektrum an Komorbiditäten zurückzuführen ist. Die hier aufgeführte Diagnostik richtet sich nach den in Deutschland gültigen S3-Leitlinen der Deutschen Gesellschaft für Pneumologie von 2010. Sowohl deutsche als auch internationale Leitlinien empfehlen zur Indikationsstellung vor lungenresezierenden Eingriffen die interdisziplinäre Falldiskussion, bei der Thoraxchirurgen, Onkologen, Radioonkologen und Pneumologen gemeinsam entscheiden. Patienten im fortgeschrittenen Lebensalter sollten immer präoperativ erweitert kardiopulmonal untersucht werden.

Abstract

The aim of preoperative lung function analysis and diagnostic cardiology is to identify patients with an increased risk of complications and to best inform the patients about treatment options and risks so that an informed treatment decision can be made. The identification of patients at increased peri-interventional risk by preoperative physiological diagnostics also forms the basis for further developments and improvements of interventions and intervention techniques in order to reduce the risk of complications. The acquisition of a detailed medical history, a thorough physical examination, and the diagnosis using ECG and spirometry may provide the first evidence for the presence of relevant comorbidities. In elective surgery a detailed preoperative evaluation of comorbidities must be done. The association of age and operative mortality is not only due to age alone, but also involves the spectrum of comorbidities. The algorithms for Germany are based on the “S3 Guidelines of the German Society of Pneumology of 2010”. Both German and international guidelines recommend the discussion of each case before lung resections in an interdisciplinary case discussion with thoracic surgeons, oncologists, radio-oncologists and pulmonologists. Patients of advanced age should always be subjected to an extended preoperative cardiopulmonary investigation.

Schlüsselwörter

Lungenfunktion - präoperative Diagnostik - Bronchialkarzinom - Lungenresektion - Leitlinien

Key words

lung function - preoperative pulmonary function analysis - lung cancer - pulmonary resection - guidelines

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