肺癌合并中度COPD患者肺叶切除术后肺功能变化及围手术期处理

Changes of Lung Function in Lung Cancer Patients with Moderate COPD after Lobectomy and Perioperative Management

【目的】探讨肺癌合并中度慢性阻塞性肺部疾病（c0PD）患者行肺叶切除手术对其肺功能的影响及围手术期处理措施。【方法】回顾性分析2003年3月至2009年1月在本院治疗的23例肺癌合并中度COPD行肺叶切除的患者，术后给予抗感染、机械辅助通气、纤维支气管镜吸痰、吸氧、平喘及呼吸物理学治疗，比较术前与术后3个月两个时期肺功能情况。【结果】患者术前最大通气量（MW），第1秒用力呼气容积（FEV1％）和动脉氧分压（Pa02）平均值分别为（40．76±4．87）L，（61．9±9．7）％和（76土8）mmHg，术后分别为（39．5±4．24）L，（59．8±8．9）%和（78±7）mmHg，差异无显著性（P〉0.05）。用力肺活量（FVC％）略有下降，但差异也无显著性（P〉0．05）。【结论】中度COPD患者仍有一定的肺功能储备，能耐受肺叶切除手术；通过加强围手术期的管理，特别是术后的密切监护以及各种严重心肺并发症的及时处理，可达到满意的手术效果。

[Objective]To explore the effect of lobectomy on lung function in lung cancer patients with moderate chronic obstructive pulmonary disease（COPD） and perioperative management. [Methods] Twenty three cases of lung cancer patients with moderate COPD who were treated in our hospital from March 2003 to January 2009 were analyzed retrospectively. After operation, anti-infection, mechanical ventilation, fiberoptic bronehoscopy suction, oxygen, relieving asthma and respiratory physical therapy were used. Pulmonary function was compared between before operation and 3 months after operation. [Results]The mean preoperative maximal ventilatory volume （MVV）, FEV1% and PaO2 were （40.76±4.87） L,（61.9±9.7）% and （76±8） mmHg, respectively. The mean postoperative MVV, FEV1% and PaO2 were （39.5±4.24）L, （ 59.8±8.9）% and （ 78±7）mmHg, respectively. There was no significant difference（ P 〉0. 05）. FVC% had a slight decrease, but there was no significant difference（ P 〉0.05） yet. [Conclusion]Moderate COPD patients still has a certain reserve to tolerate lobectomy. Perioperative management, especially postoperatively close care and prompt treatment of serious heart and lung complications, can achieve satisfactory results.