腹型肥胖对胸腔镜肺叶切除围手术期肺功能的影响

Effect of abdominal obesity on lung function in the perioperative period of complete video-assisted thoracoscopic lobectomy

目的 观察腹型肥胖对胸腔镜肺叶切除围手术期肺功能的影响.方法 按准入条件选取周围型肺癌且有胸腔镜手术指征的患者36例,将体质量指数（BMI）＞ 35 kg/m2,男性腰围＞95 cm,女性腰围＞90cm的18例设为腹型肥胖组,BMI＜ 25 kg/m2,男性腰围＜85 cm,女性腰围＜80 cm的18例设为正常体质量组,均采取4孔法完成胸腔镜肺叶切除及淋巴结清扫术,记录手术时间,手术前后查血气分析及肺功能,记录术后并发症,比较二组各参数的关系.结果 二组术前血气分析指标比较差异无统计学意义（P＞0.05）,术后12h腹型肥胖组自身比较动脉血氧分压（PaO2）下降、肺泡动脉血氧分压差（PA-aO2）升高,较正常体质量组PaO2明显降低,动脉血二氧化碳分压（PaCO2）、PA-aO2增高,差异有统计学意义（P＜0.05）;二组术前用力肺活量（FVC）、（FEV1）比较差异有统计学意义（P＜0.05）,术后第3天腹型肥胖组自身比较,除FEV/FVC外,FVC、FEV1、最大通气量（MVV）、功能残气量（FRC）、一氧化碳弥散量（DLCO）均明显降低,较正常体质量组比较,FVC、FEV1、FRC、DLCO均明显降低,差异有统计学意义（P＜0.05）;腹型肥胖组术后较自身FVC、FEV1、MVV、FRC、DLCO分别下降了25.8％,27.8％,20.4％,32.1％,39.1％,而较正常体质量组术后FVC、FEV1、FRC、DLCO下降更明显,分别为31.8％,37.2％,30.2％,30.6％;腹型肥胖组术后并发症增多.结论 胸腔镜肺叶切除围手术期中,腹型肥胖对肺功能的影响较大,应引起高度重视,有效控制肥胖对手术患者有重要意义.

Objective To observe the effect of abdominal obesity on lung function in the perioperative period of complete video-assisted thoracoscopic lobectomy.Methods Collected 36 cases of peripheral lung cancer and could complete video-assisted thoracoscopic lobectomy by access conditions,18 cases in abdominal obesity group who had body mass index （BMI） ＞ 35 kg/m2 and the waist circumference ＞ 95 cm on men the waist circumference ＞ 90 cm on women,18 cases in normal weight group who had BMI ＜ 25 kg/m2 and the waist circumference ＜ 85 cm on men the waist circumference ＜ 80 cm on women.All cases had complete video-assisted thoracoscopic lobectomy and lymph node dissection with 4 holes,and recorded the operation time,before and after operation had blood gas analysis and lung function,at the same time recorded the cases of complication after operation,compared the parameters in two groups.Results The blood gas analysis had no difference before operation,but after 12 h of operation,the arterial blood oxygen partial pressure （PaO2） declined and alveolar-arterial blood oxygen partial pressure difference（PA-aO2） increased in abdominal obesity group,while the PaO2 declined and arterial blood CO2 partial pressure （PaCO2）,PA-aO2 increased compared with normal weight group（P ＜ 0.05）.The forced vital capacity （FVC）,forced expiratory volume in 1 second（FEV1） had statistical significance in two groups before operation（P ＜ 0.05）,on the third day after operation,the abdominal obesity group to himself the FVC,FEV1,maximal voluntary rentilation （MVV）,functional residual capacity （FRC）,carbon monoxide diffusion amount （DLCO） declined obviously except FEV1/FVC （P ＜ 0.05）,compared with normal weight group,the FVC,FEV1,FRC,DLCO declined obviously （P ＜ 0.05）.After operation,the lung function in abdominal obesity group,the FVC,FEV1,MVV,FRC,DLCO declined 25.8％,27.8％,20.4％,32.1％,39.1％,compared with normal weight group the FVC,FEV1,FRC,DLCO declined 31.8％,37.2％,30.2％,30.6％.The abdominal obesity group had more complication.Conclusion In the perioperative period of complete video-assisted thoracoscopic lobectomy,the abdominal obesity has more effect to lung function and must have more attentions on it,and effective weight control has important significance to operation patients.