肺减容手术治疗重度肺气肿的临床研究

Clinical exploartion of lung volume reduction surgery in patient with severe emphysema

目的评价肺减容手术对重度肺气肿患者的疗效。方法36例重度肺气肿患者行肺减容手术,双侧8例,单侧28例。术前、术后3、6个月分别测量动脉血气(PaO2,PaCO2)、肺功能(FEV1、RV、TLC)、6分钟运动试验(6-MWD),并对其结果进行比较分析。结果本组无手术死亡,均痊愈出院;术后动脉血氧分压比术前明显提高(P<0.05),二氧化碳分压比术前明显降低(P<0.05);术后3、6个月的FEV1、6-MWD较术前有明显提高(P<0.05),RV、TLC较术前有明显降低(P<0.05);呼吸困难指数再分级,26例术前Ⅲ级中10例转为Ⅰ级,16例转为Ⅱ级;10例Ⅳ级中3例转为Ⅰ级,5例转为Ⅱ级,2例转为Ⅲ级。结论重度肺气肿患者选择性手术,能改善患者肺功能,提高生活质量。

Objective To evaluate the effects of lung volume reduction surgery (LVRS) in patients with severe emphysema.Methods Thirty-six patients with severe emphysema underwent LVRS,including bilateral LVRS in 8 patients and unilateral LVRS in 28 patients.The results of lung function (FEV_1,RV ,TLC),arterial blood gas analysis (PaO_2,PaCO_2) and walking diatance in 6 min (6-MWD) were analyzed 3 months,6 months before and after LVRS.Results There was no perioperative death in this group.FEV_1,RV,TLC were improved significantly after surgery (P<0.05).PaO_2 was increased (P<0.05) and PaCO_2 decreased postoperatively(P<0.05).The 6-MWD was significantly increased after surgery.For dyspnea scale,among 26 patients with a preoperative grade of Ⅲ,10 patients were improved to grade Ⅰ,16 to grade Ⅱ.Among the 10 patients with a preoperative grade of Ⅳ,2 were improved to grade Ⅰ,5 to grade Ⅱ,and 2 to grade Ⅲ.Conclusion LVRS can improve the respiratory function and quality of life for selected patients with severe emphysema.