食管、贲门癌不同术式围手术期动脉血气的动态变化及其与术后心肺并发症的关系

Dynamic changes of peri operative aterial blood gas analysis as for different operation and the relation to the cardio pulmonary complications in esophageal or gastric cardia cancer

目的 评估食管癌、贲门癌不同术式术后早期动脉血气指标的变化及其与术后心肺并发症的关系。方法 92例食管、贲门癌患者入组研究 ,于术前 1周及术后 1～ 4日行动脉血气分析。结果 全组术后 1～ 4日动脉血氧分压(PaO2 )均较术前明显降低 (P <0 .0 5 )。术前低肺功能者血气指标变化更著 (P <0 .0 5 )。主动脉弓上 /颈部食管重建术者PaO2 的降低程度甚于主动脉弓下重建术者 (P <0 .0 5 )。保留膈肌功能的右侧剖胸术术后PaO2 的恢复较快。结论 食管癌、贲门癌各式剖胸手术均可导致术后低氧血症。其可能的原因为VA/Q失调 ;其程度与术前肺功能的状况及手术方式有关。术后低氧血症与心肺并发症的发生密切相关。

? Objective To evaluate the early change of aterial blood gas indexes following a variety of esophagogastrectomy and the relationship to the cardio pulmonary complications.Methods 92 cases with esophagealorgastric cardia cancer patients were studied.The indexes of aterial blood gas were tested preoperation and on 1st to 4th day after operation.Results The average artery blood oxygen pressure (PaO 2) after operation was significant lower than that before operation (P<0.05),especially in the group with pulmonary dysfunction before operation (P<0.05).The PaO 2 in the cases with anastomosis above the aortic arch or at neck was obviously lower than those with anastomosis below the aortic arch(P<0.05).The right thoracotomy preserved diaphragm function was benefit to recover PaO 2 of patients after operation. Conclusions All of the different esophagectomies through open thoracotomy can result in low blood oxygen condition,and the potential reason may be the disorder of Va/Q.The degree of the low PaO 2 after operation associated with the abnormal pulmonary function before operation and the type of operation.The pulmonary cardiac complications are closely related to the low blood oxygen condition following operation. 〔