老年低肺功能肺癌病人RVEF与并发症发生的关系及围手术期处理

Relationship Between RVEF and Postoperative Complications in Elderly Lung Cancer Patients with Poor Pulmonary Function and Management of Perioperative Period

【目的】探讨老年低肺功能肺癌病人右心室射血分数(RVEF)与并发症发生的关系及围手术期处理经验。【方法】对1997年8月至2007年10月手术治疗的老年低肺功能肺癌病人128例,术前测定RVEF,按RVEF值分成<0.45及≥0.45两组,比较两组患者手术并发症发生情况。【结果】全组119例治愈,住院死亡9例,发生并发症73例,其中RVEF<0.45组并发症总发生率为78.1%(68/87),明显高于≥0.45组的12.1%(5/41),发生呼吸衰竭18例。【结论】老年低肺功能病人并发症的发病率随RVEF的降低而升高。患者右心功能与并发症的发生有密切关系。术后强化呼吸道管理及合理使用呼吸机能为手术成功创造有利条件。

[Objective] To explore the relationship between the right ventricular ejection fraction（RVEF） and postoperative complications in elderly lung cancer patients with poor pulmonary function. [Methods]From August 1997 to October 2007, 128 elderly patients with lung cancer who had poor lung function underwent thoracotomy in our hospital. RVEF was consecutively assessed before pulmonary resection by echocardio graphy. According to RVEF, all patients were divided into two groups： group A （ n = 85, RVEF〈0.45） and group B （ n = 43, RVEF〈0.45）. All patients received pneurnonectomy. [Results] The operative mortality was 7% （9/128） and the overall complication incidence was 57% （73/128）. The complication incidence in group A was 78.1%（68/87） and the incidence in group B was 12.1% （5/41）. [Conclusion] The patients in aged and with poor lung function with a preoperative RVEF less than 0.45 had a significantly high incidence of complications. Perioperative intensive management is very important for establishing operation indications and tiding over critical period.