振荡肺功能检测在胸外科术后的应用

Application of Impulse Oscillometry in Patients with Thoracotomy

目的:用脉冲振荡肺功能检测探讨开胸手术对肺功能的损害及术后近期演变规律的影响。方法:采用脉冲振荡方法分别于术前、术后1、2、3、5、7d,连续测定53例开胸不同手术切除范围患者的肺功能,并观察分析其变化规律。结果:肺叶切除、全肺切除和单纯开胸手术术后呼吸总阻抗(Zrs)、总气通(R5)、中心气道阻力(R20)、频率响应点(Fres)、周边弹性阻力(X5,绝对值)均在术后第1天明显升高(均P<0.05),肺叶切除和单纯开胸探查组在术后第2天开始明显回落,而全肺切除组术后第2～5天维持在较高水平,第7天略有下降,但与另外2组比较仍显著增高(均P<0.05);肺叶切除与单纯开胸探查组各观察值之间比较差异均无统计学意义(均P>0.05)。结论:手术切除范围对开胸术后早期呼吸功能的影响显著。全肺切除对呼吸功能影响较大,且恢复缓慢。脉冲振荡肺功能检测操作方便,能反映大小气道的阻力、阻塞的部位和肺组织的功能状态,对评估接受开胸手术患者术后的肺功能状况有一定的临床意义。

Objective： To study the respiratory impedance change curves by impulse oscillometry （IOS） within one week after thoracotomy for the purpose of preventing and curing the postoperative complications. Methods： Fifty-three patients were chosen randomly, who undergoing thoracotomy through posterolateral incision without serious preoperative complication. These consisted of 31 lobeetomies, 9 pneumectomies, and 13 exploratory thoracotomy cases. The lOS values were mensurated preoperatively and 1, 2, 3, 5 and 7 days postoperatively. The changing curves of lOS were made and the influence factors were analyzed by SPSS11.0 medical statistic software. Results： The values of Zrs, R5, R20, Fres and X5 （absolute value） in patients with lobectomy, pneumectomy and exploratory thoracotomy rised obviously 1 day postoperatively. The values of IOS in patients with lobectomy and exploratory thoracotomy decreased 1 day postoperatively, but the values of IOS in patients with pneumectomy still lasted a higher level. Compared with the other two groups, the difference was significant. The difference of ISO values between lobectomy and exploratory thoracotomy patients was not significant. Conclusion： Postoperative trauma and scope of resection are the most important factors which influence early postoperative lung function. Pneumectomy makes postoperative pulmonary function lower than other operation styles, and it makes recovery slower. The values of IOS can reflect postoperative respiratory physiological changes, and assess postoperative pulmonary function outstandingly.