慢性阻塞性肺疾病胸部手术心肺并发症与术前肺功能关系的临床研究

Clinical study about relation between COPD thoracic operative complications and preoprative pulmonary function

目的 探讨慢性阻塞性肺疾病 (COPD)患者术后近期心肺并发症与术前肺功能的关系。方法 肺癌 3 9例、食管癌 12例术前 1周内测定全部通气指标 ,术前及术后 1、2、3d监测动脉血气分析和心电监护。结果 术后心肺并发症总发生率为 5 4.9% ,肺炎 16例 ,8例并发呼吸衰竭 ,其中死亡 6例 ;心律失常 12例。心律失常的发生与术前最大通气量 (MVV)、1s用力呼气容积 (FEV1)、用力肺活量 (FVC)异常状态无关 ,与动脉血氧分压 [P(O2 ) ]有关 ,当P(O2 ) <70mmHg( 1mmHg =0 .13 3kPa)时各种心律失常增多 ;肺炎的发生与MVV、FEV1、和P(O2 )无直接关连 ,而与术前、术后平喘和抗生素应用有关 :死亡 6例中术前MVV、FEV1、FVC、P(O2 )分别小于 5 0 %、5 0 %、60 %、70mmHg ;当MVV、FEV1、和FVC三项均低于5 0 %时 ,呼吸衰竭的发生率显著增高。结论 为减少COPD患者胸部手术心肺并发症的发生 ,术前MVV、FEV1两项中至少一项达 5 0 %以上 ,FVC应大于 60 % ,P(O2 ) >70mmHg ,术前全身应用有效抗生素 ,改善通气功能 ,术后常规给予平喘、祛痰及抗生素 ,密切观察动脉血气和心电监测。

Objective To probe the relation between postoperative complications in the near future and preoperative pulmonary function of COPD.Methods There are 39 cases of lung cancer and 12 cases of esophagus cancer. To determine all of the ventialtion index in a week before operation and watch arterial blood gas analysis and electrocardio graphie monitoring in the days before the operatlon and the first、second、third dqy after that.Result The postoperative total incidence rate of the cardiopulmonary complicatios is 54.9%, there are 16 cases of pneumonia in which 8 cases of respiratory failure 5 cases of death,12 cases of arrhythmia.The arrhy thmia is related to P(O 2)in stead of the preoperative abnormal state of MVV、FEV 、and FVC、when P(O 2) is beneath 9.3 kPa all kinds of arrhy thmia will increase;pneumoniais related to the use of antiasthmatic and antibiotic be fore and after operation,but not directly related to MVV、FEV、FVC and P(O 2); Among the 6 cases of death preoperative value of MVV、FEV 1、FVC、P(O 2)are smaller than 50%、50%、60%、70 mm Hg respectively. The incidence rate of respiratory failure will increase significantly when the value of MVV、FEV 1 and FVC are smaller than 50%. Conclusion In order to decrease COPD patients'thoracic operative cardiopulmonary complications, it is required that the one of MVV and FEV 1 should surpass 50% at least, FVC should surpass 60%, P(O 2) should surpass 70 mm Hg, and it is also required to use effective antibiotic generally before operation, to inprove ventilatory function,to give antiasthmatic, expectorant and antibiotic routinely after operatin to pay attention to arterial blood gas and electrocardiographic monitoring.