上腹部手术对肺功能的影响

Effects of Upper Abdominal Surgery on pulmonary Function

为探讨手术与麻醉对肺功能的影响，对２５例上腹部手术（ＵＡＳ）患者术后肺功能的掼害和恢复进行了连续观察。手术前后分别用肺功能测定仪测量肺通气功能和血气，并于不同体位（坐位和仰卧位）测量功能余气量（ＦＲＣ）。结果显示：ＵＡＳ后呼吸频率（Ｒ）增加，潮气量（ＶＴ）减少，分钟通气量（ＶE）无明显改变。术后肺活量（ＶＣ）和用力肺活量（ＦＶＣ）等明显下降，手术当天ＦＶＣ为术前的２７．１％，至术后第７天恢复至术前６９．６％。ＰａＯ２术前为１０．５７±１．４６ｋＰａ，术后第Ｊ、３天分别为９．６１±１．４５和９．６９±１．３８ｋＰａ，同期肺泡一动脉血氧分区差［Ｐ（Ａ－ａ）ＤＯ２］梯度增加。硬膜外阻滞术后坐位时ＦＲＣ无明显改变，仰卧位时在术后第１、７天分别为术前的７５．４％和９５．８％。麻醉和手术时间越长，肺功能损害越重。本文证实ＵＡＳ后肺功能严重受损，气体交换障碍，术后坐位时ＦＲＣ无明显改变，仰卧位时减少。

The impairment and recovery of pulmonary function were assessed in 25 patients undergoing upper sbdorninal surgery (UAS). Pulmonary function and blood gas were measured pre- and postoperative day (POD) by computerized spirometer and blood gas analyzer,and FRC were measured on different positipn(sitting and supine). UAS was constantly associated with a increase in R and a decrease in VT. FVC measured 27. l% of preoperative function on the day of operation and recovered to 69. 6% preoperatively on POD7. The changes trend of the other indices of pulmonary function after UAS were similar to that of FVC. Pao2,value was 10. 57± l. 46kpa preoperatively and 9. 61 ± 1. 45, 9. 69 ± 1. 38kpa (p<0- 05) on the PODI .POD3. P(A-a)- O2 value increased on the corresponding period. The FRC of the patients undergoing UAS with epidural block were no significant change on sitting position, but decreased on supine position. It measured 75. 4% and 95. 8% of preoperative function on PODI and POD7. It is concluded that the function of the pulmonary ventilation and gas exchange were significant impairment following UAS.