脊柱后路手术对呼吸肌力量及呼吸功能的影响

Change of respiratory muscle strength and capacity in the postoperative period of spinal surgery by posterior approach

目的探讨脊柱后路手术患者术后呼吸功能及呼吸肌力量的变化规律,为预防术后呼吸系统并发症提供依据。方法测量148例后路脊柱手术患者术前和术后第1、2天的肺活量、潮气量、每分钟通气量、最大吸气压力、最大呼气压力,并与手术时间、手术部位、手术原因行相关性分析。结果术后第1、2天呼吸功能及呼吸肌力明显下降,手术时间≥240 min和手术部位为颈、胸椎以及手术原因是肿瘤的患者下降尤其明显(P<0.05)。结论脊柱手术对患者呼吸功能和呼吸肌力的影响除了全身麻醉手术的共同因素外,还与手术区域有关,特别是与膈神经的损伤有关。术前合理的手术方案和呼吸机能的锻炼、术中手术时间的控制、术后预防呼吸道并发症的措施,可减轻手术对呼吸系统的破坏,降低呼吸系统并发症。

Objective To analyze vital capacity （ VC） , ventilometry, respiratory muscle in patients submitted to spi-nal surgery by posterior approach for tumor or herniated disc, and to investigate the possible association of respiratory fuction with surgery duration, site of surgical access, and diagnosis. Methods 148 patients′tidal volume（ TV） , vi-tal capacity（ VC） ,minute volume（ MV） , respiratory frequency（ f） , maximal inspiratory pressure（ PImax ） , and maxi-mal expiratory pressure（ PEmax ） were measured. Results Patients submitted to spinal surgery showed a decrease in the first and second postoperative days in respiratory capacity and respiratory muscle strength （P〈0. 05）. Reduction of respiration more associated with surgical time ≥240 minutes, diagnosis of tumor, and cervicothoracic surgical ac-cess （P＜0. 05）. Conclusions Alterations in the respiratory function in the posteoperative period of elective spinal surgery for tumor removal or herniated disc are related to surgical time≥240 min, tumor, or cervicothoracic surgical access. Special management for respiratory care should be made for these patients during posteoperative period.