重症肺气肿患者应用双侧肺减容术的麻醉处理

Anesthesia Treatment of Lung Volume Reduction Surgery in Patients with Severe Pulmonary Emphysema

目的探讨重症肺气肿患者行双侧肺减容术的麻醉处理方法。方法方便选取2015年6月—2016年6月该院收治的42例重度肺气肿患者作为研究对象,均行双侧肺减容术,麻醉方式采用低浓度吸入麻醉+硬膜外阻滞麻醉,观察麻醉效果。结果该组患者在麻醉及手术过程中的血流动力学基本稳定,术后37例顺利拔管,5例保留导管。术后未发生麻醉相关并发症,全部治愈出院。患者术后6个月的FEV1、PaO_2水平分别为(46.6±12.4)%、(88.4±5.3)mmHg,均较术前显著提高,RV、TLC、PaCO_2水平分别为(146.6±5.8)%、(90.2±18.3)%、(49.4±4.8)mmHg,均较术前显著降低(t=6.870、10.492、12.948、11.994、12.219,P<0.05)。术后6个月的呼吸困难分级:Ⅰ级10例,Ⅱ级21例,Ⅲ级11例,与治疗前相比(Ⅱ级8例、Ⅲ级22例、Ⅳ级12例),差异有统计学意义(χ~2=33.426,P<0.05)。结论重症肺气肿患者行双侧肺减容术采用低浓度吸入麻醉+硬膜外阻滞麻醉具有较好的麻醉效果,且安全性好。

Objective To summarize the anesthesia treatment of lung volume reduction surgery in patients with severe pulmonary emphysema. Methods 42 cases of patients with severe pulmonary emphysema admitted and treated in our hospital from June 2015 to June 2016 were convenient selected as the research objects and were treated with lung volume reduction surgery, and the anesthesia way was the low-concentration inhaled anesthesia and epidural block anesthesia, and the anesthesia effect was observed. Results The hemodynamics was basically steady in the anesthesia and operation courses, after surgery, the tube of 37 cases successfully extracted, and the catheter of 5 cases was reserved, and anesthesia related complications did not occur after surgery, and all discharged after healing, and the FEV1 and PaO_2 levels in six months after surgery were respectively（46.6 ±12.4）%,（88.4 ±5.3）mmHg, which obviously increased compared with those before surgery,and the RV,TLC,PaCO_2 levels were respectively（146.6±5.8）%,（90.2±18.3）%,（49.4 ±4.8）mmHg, which obviously decreased compared with those before surgery（t=6.870,10.492,12.948,11.994,12.219,P〈0.05）, in terms of dyspnea classification in six months after surgery, there were 10 cases in level Ⅰ, 21 cases in level Ⅱ, 11 cases in level Ⅲ, and those indicators before treatment were 8 cases in level Ⅱ, 22 cases in level Ⅲ and 12 cases in level Ⅳ, and the differences were obvious（χ~2=33.426,P 0.05）. Conclusion The effect of low-concentration inhaled anesthesia and epidural block anesthesia of patients with severe pulmonary emphysema in the lung volume reduction surgery is better, with good safety.