Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery （LVRS） can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms. Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups. Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO2, PaCO2, dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B. Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded the surgical indication for tumor patients.     

EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

Objective To evaluate the effect of the cardiopulmonary bypass （CPB） on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect （VSD）. Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups： pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded： duration for mechanical ventilation （Tmv） and staying in the cardiac intensive care unit （Tcicu） after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group （ P 〈 0. 01 ）. By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group （ P 〈 0. 05 ）, especially at 6, 9, and 15h after CPB （ P 〈0. 01 ）. In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB （ P 〈0. 05）. There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.     

SURGICAL EXPERIENCE OF COMPLEX CONGENITAIL HEART DEFECTS IN CHILDREN AND INFANTS

From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9.31%. On the basis of our clinical experience, it is important that the accurate diagnosis was made promptly in neonate with complex CHDs. The surgical results can be improved by the use of PGEI and balloon atrial septostomy in the cyanotic neonate. For the congestive CHDs, the operation must be per formed in the early life to prevent pulmonary hypertension. Improved methods of preoperative and postoperative care have contributed to these results.     

Surgical intervention for advanced valvular heart disease in 227 cases

Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Methods From January 1994 to October 2003, surgical procedures of heart valve replacement were performed on 227 (136 men and 91 women) patients with AVHD in our Department of Cardiothoracic Surgery. The clinical data of all patients were collected and analysed. Patients’ age ranged from 10 years to 77 years. In preoperative cardiac function grading, 157 cases were NYHA III and 70 cases NYHA IV. Fifty-one patients had had cardiac operations. The ultrasonic cardiac graphs showed that 145 patients suffered from moderate or severe pulmonary hypertension and 73 had combined giant left ventricle. Mitral valve replacement was performed in 32 cases, aortic valve replacement in 90, tricuspid valve replacement in 1, combined mitral and aortic replacement in 103 and combined mitral and tricuspid replacement in 1. Nineteen patients also received surgical corrections for other minor abnormalities during the operations. A logistic model was established to evaluate the influence of perioperative factors on the mortality rate. Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976. Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.     

An in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition

Background The application of pulmonary valved conduit to reconstruct the continuity between right ventricles and pulmonary artery is one of the major surgeries.This study aimed to establish an in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition to validate the long-term effects of artificial pulmonary valved conduit.Methods Domesticate juvenile male sheep and tissue-engineered poorine pulmonary valved conduit were used for the experiment：30 sheep,weighing （15±3） kg （range 13 to 17 kg） were randomly divided into two groups which were all operated under general anesthesia by off-pump surgery （group 1） and left thoracotomy （group 2）.Two different off-pump surgical methods were used to perform cannulation in sheep pulmonary artery to replace part of sheep pulmonary artery with pulmonary valved conduit which will work together with sheep pulmonary artery and valves.During the experiments,animal survival,complication rates,operating time and blood loss were recorded to compare the results between groups and to establish a surgical method with minimal invasion,simplicity,safety,and high success rates.Results In group 1,a total of 15 cases of surgeries were performed,in which two sheep died; the operative mortality was 13.3％ （2/15）.In group 2,a total of 15 cases of surgeries were performed,and the surgical mortality rate was 0 （0/15）.The operation time and blood loss in group 2 was significantly better than that in group 1.The postoperative echocardiograms showed that,after the surgeries by these two methods,the blood flows were normal,and the valves can open and close freely.Autopsy after 6 months showed that the inner wall and the valves of pulmonary valved conduit were smooth with no thrombus formation.Conclusion These two off-pump methods are feasible and safe with fewer traumas; but the second method is better and particularly suitable for the establishment of a juvenile animal model.     

Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET） for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs （spirometry ＋ single-breath carbon monoxide diffusing capacity of the lungs （DLCOsb） for diffusion capacity） and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone （15 cases） and operation-related complications （6 cases）. Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients （25.2%） had postoperative cardiopulmonary complications. Three patients （1.5%）died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients＇ cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in addition to conventional pulmonary function tests, and both should be combined to assess cardiopulmonary function status.     

Relationships among pain intensity and Heart Rate Variability in Patients after Abdominal Surgery : A pilot study

Background A link between postoperative pain intensity and heart rate variability had not been well established. This study aims to investigate the correlation between postoperative pain intensity and heart rate variability. Methods The subjects in this cross-sectional correlation study comprised patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009 to November 2009. The Visual Analogue Scale (VAS) and the Short-Form McGill Pain Questionnaire (SF-MPQ) were used to measure postoperative pain. Heart rate variability was measured as standard deviation of normal RR interval (SDNN), and by power spectral analysis where high frequency (HF), low frequency (LF), very low frequency (VLF) power, and LF/HF ratio. Results A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50 ± 20.98 and the mean SF-MPQ score was 18.06 ± 8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The SDNN and HF values obtained from male patients or married patients were higher than female patients or unmarried (p< 0.05). The correlation of the SDNN, HF, VLF value and patient's age were negative (p< 0.05). The total SF-MPQ pain scores positively correlated with the LF/HF ratio (p< 0.05). Conclusions We concluded that the multidimensional pain assessment tool (SF-MPQ) better reflects patients’ postoperative pain than the single-dimensional assessment tool (VAS). Heart rate variability positively correlated with SF-MPQ scores in patients after abdominal surgery.     

Effects of Glutamine Supplementation on Patients Undergoing Abdominal Surgery

Objective To evaluate the effects of supplementation of glutamine （GLN） on maintaining glu- tathione （GSH） level, immune system function, liver function, and clinical outcome of patients receiving abdominal operation. Methods Forty patients undergoing elective abdominal surgical treatment were randomly divided into 2 groups： study group （n=20） and control group （n=20）. All patients received total parenteral nutrition （TPN） for up to 7 days during perioperative period. The study group received TPN supplemented with GLN dipeptide while the control group received TPN without GLN dipeptide. Patients in both groups received equivalent nitrogen and caloric intake. Blood sample was taken on preoperative day, and the 1st, 3rd, 6th postoperative day to measure GSH level, immune indexes, and liver function indexes. Results The decrease of GSH level in plasma and red blood cell （RBC） in study group was less than that in control group during postoperative period. Ratio of GSH/glutathione disulfide （GSSG） in plasma in study grouP was higher than that in control group on the 3rd postoperative day （52.53±11.46 vs. 31.43±7.27, P = 0.001）. Albumin level in study group was higher than that in control group on the 3rd postoperative day （37.7±3.8 g/L vs. 33.8±4.2 g/L, P = 0.02）. There was no significant difference in the levels of immunoglobin （IgG, IgM, IgA） or T lymphocyte subgroup （CD4, CD8, CD4/CD8） in both groups during postoperative period. There was one case with infectious complication in control group, while none in study group. A trend of shortened hospital stay was observed in study group compared with control group （22.3±2.1 d vs. 24.9±1.7 d,P= 0.32）. Conclusions Supplementation of GLN-enriched TPN has beneficial effects on maintaining GSH levels in plasma and RBC, sustaining GSH/GSSG ratio and albumin level, and keeping antioxidant abilities during postoperative period in patients with abdominal operation, with the trends of decreasing incidence of infectious complication and shortening hospital stay.     

Using quantitative CT to predict postoperative pulmonary function in patients with lung cancer

Background At present, the therapy for patients with lung cancer that achieves a high rate of cure is surgical resection at an early stage of the disease. The aim of this study is to evaluate quantitative computed tomography (QCT) for predicting postoperative pulmonary function in patients with lung cancer. Methods The data of thirty-one patients with lung cancer who underwent both pulmonary functional tests and QCT scan before operations were collected. A CT program was used to quantify the volume of whole lung parenchyma with attenuation of -910 HU to -600 HU, which was defined as total functional lung volume (TFLV). Similarly, the volume of lung (lobes or segments) with attenuation of -910 HU to -600 HU was defined as regional functional lung volume (RFLV). Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FVC% and FEV1% (ratio to reference values of the matched population) were obtained from preoperational pulmonary functional tests. According to the formula: predicted FVC (pre-FVC)=preoperative FVC×［1－（RFLV/TFLV）］; predicted FEV1 (pre-FEV1)=preoperative FEV1×［1－（RFLV/TFLV）］, we obtained values of predicted FVC, predicted FEV1, predicted FVC% (pre-FVC/reference values of the matched population), and predicted FEV1% (pre-FEV1/reference values of the matched population). The paired t test and Pearson correlation test were used to assess significance of differences and correlations between CT predicted values and postoperative measured results of FVC, FEV1, FVC% and FEV1%. Results QCT predicted values correlated well with postoperative FVC, FEV1, FVC% and FEV1% （r=0.873, 0.809, 0.849 and 0.801 respectively, all P&lt;0.01).Conclusions QCT is an effective and accurate way to predict postoperative pulmonary function in patients undergoing pulmonary resection, regardless of the patients’ preoperative pulmonary functional status.     

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF STOMACH CARCINOMA PAIN

Clinical observation on 48 cases of stomach carcinoma pain indicated that acupuncture including filiform needle group and point-injection group had better therapeutic effects in treatment of stomach carcinoma pain when patient's mind was concentrated at the site of disease. After treatment for 2 months, the long-term effective rates of analgesia in both the filiform needle group and the point-injection group were similar to that in the western medicine group, all being about 81%. While the long-term markedly effective rates in the two groups were superior to that in the western medicine group. Life quality of the patients in all the groups were improved. The toxic action and side effects caused by chemotherapy were prevented, the high viscous state showed by indexes of blood rheology was unproved, and the lowered Cu-Zu-SOD activity in erythrocytes in patients of stomach carcinoma was increased in the filiform needle group and the point-injection group. Based on the results of clinical study, we consider that acupuncture analgesic effect on stomach carcinoma is related to the increase of PLEK, improvement of cellular immune function and the elevation of life quality after acupuncture.     

胸部手术肋间神经冷冻镇痛作用的临床研究

目的:探讨胸部手术肋间神经冷冻镇痛的疗效。方法:对120例开胸手术患者进行分组,分为肋间神经冷冻组和镇痛泵组各60例,按照视觉模拟评分法观察两组患者术后胸部疼痛情况,术后第1、3、7、14天分别对每组患者行肺功能检查。结果:冷冻组术后镇痛效果满意,患者视觉模拟评分明显低于对照组,两组比较差异有统计学意义(P<0.01),冷冻组患者术后肺功能恢复时间较快,在术后第1、3、7天与对照组相比差异有统计学意义(P<0.05),而术后第14天,两组患者肺功能比较差异无统计学意义(P>0.05)。结论:肋间神经冷冻治疗对开胸手术后镇痛效果明显,不会对肋间神经造成永久性损害,患者术后肺功能可早期恢复,能有效降低肺部并发症,值得临床推广。     

食管癌、贲门癌术后急性呼吸衰竭的危险因素分析

目的:探讨食管癌、贲门癌术后发生急性呼吸衰竭(acute respiratory failure,ARF)的危险因素,为针对性预防其发生提供临床指导依据。方法:将1995年1月~2005年1月期间食管癌、贲门癌术后发生ARF的42例患者临床资料,与按1∶2比例随机抽取的同期手术后未发生ARF的84例食管癌、贲门癌患者的资料做对照,应用Logistic回归分析比较两组患者的年龄、性别、吸烟指数、术前肺功能、术前有无肺部合并症和其它合并症、术前有无低蛋白血症、吻合口位置、手术时间、术后是否镇痛、术后有无其它并发症等与术后发生ARF的相关强度,推测可能导致术后ARF发生的危险因素。结果:患者术前肺功能中重度受损、吸烟指数>400支/年、术前有肺部合并症和手术时间>3h,四个因素与术后ARF发生有显著相关性(P<0.05)。结论:术前改善低肺功能、早期戒烟、积极治疗肺部合并症、提高手术技巧,缩短手术时间是预防和减少术后ARF发生的重要环节之一。     

肋间神经冷冻术在胸部手术后镇痛的临床研究

目的探讨肋间神经冷冻在胸部术后的镇痛效果。方法将200例单纯后外侧切口开胸手术患者随机分为观察组（肋间神经冷冻治疗组）100例和对照组100例,比较两组患者术后镇痛效果、肺部并发症发生率、术后使用麻醉镇痛药及肺功能情况。结果观察组患者疼痛程度显著弱于对照组（P〈0．01）;术后咳嗽、咳痰评分优良率显著高于对照组（P〈0．01）;肺部并发症发生率显著低于对照组（P〈0．01）;术后3d内镇痛药需求量也显著低于对照组（P〈0．01）。观察组术后肺功能恢复时间较快,肺功能在术后第3天及第7天与对照组相比有显著差异（P〈0．01）。结论肋间神经冷冻治疗对开胸手术后镇痛效果明显,能减少肺部并发症发生,且不会对肋间神经造成永久性损害,是一种简便、有效、安全的镇痛方法,值得临床大力推广使用。     

肺癌根治术后肺部感染的相关因素分析

  目的  探讨肺癌根治术后肺部感染的相关影响因素,为预防和降低肺癌根治术后肺部感染几率提供方法依据。  方法  选取2018年2月—2020年2月在浙江省人民医院心胸外科行肺癌根治术的患者82例,根据是否发生肺部感染分为肺部感染组(23例)和非肺部感染组(59例)。收集和整理患者的一般临床资料,分析肺癌根治术后肺部感染的相关影响因素。  结果  82例患者术后肺部感染发生率为28.05%。单因素分析结果显示患者的性别、是否伴有高血压、术前肺功能、肺叶切除部位、病理类型、病理分期与术后肺部感染无显著相关性(均P>0.05);年龄(≥60岁)、切口VAS评分(4~10分)、长期吸烟史、合并慢性阻塞性肺疾病(COPD)、糖尿病(DM)、手术时间(≥3 h)、手术方式(传统开胸手术)、机械通气时间(≥6 h)、胸腔引流管留置时间(≥4 d)与肺部感染密切相关(均P < 0.05)。Logistic多因素分析显示,年龄大(≥60岁)、手术时间长(≥3 h)、合并COPD、DM、手术方式(传统开胸手术)、长期吸烟史、切口VAS评分(4~10分)、胸腔引流管留置时间长(≥4 d)是肺癌根治术患者术后发生肺部感染的独立影响因素(均P < 0.05)。  结论  肺癌根治术后肺部感染发生率较高,术后发生肺部感染的影响因素较多,其中年龄大(≥60岁)、手术时间长(≥3 h)、合并COPD、DM、手术方式(传统手术)、长期吸烟史、切口VAS评分(4~10分)、胸腔留置引流时间长(≥4 d)是肺癌根治术患者术后发生肺部感染的危险因素,今后应在临床上针对上述危险因素采取积极处理措施,以降低术后肺部感染发生率。      

食管癌术后并发肺部感染的危险因素分析

目的探讨食管癌术后并发肺部感染的危险因素,以降低食管癌术后肺部感染的发生率。方法收集2010年1月~2013年1月我院治疗的食管癌患者80例,发生肺部感染10例,未发生肺部感染70例,对两组患者的相关因素,包括年龄、性别、吸烟史、吸烟时间、合并基础疾病、手术方法、手术时间、术前血红蛋白、术前放疗与否、术中喉返神经损伤与否、术前血清白蛋白、术中是否使用自控硬膜外镇痛(PCEA)情况进行对比分析。结果年龄≥60岁、合并基础疾病、术前营养不良(术前血红蛋白≤100g/L、白蛋白≤30g/L)、术前未进行化疗、行开胸手术、未使用PCEA、有吸烟史、吸烟时间≥20年的食管癌患者肺部感染发生率较高(P<0.05或P<0.01)。将上述单因素进行多因素非条件Logistic回归分析:年龄≥60岁、合并基础疾病、术前营养不良(术前血红蛋白≤100g/L、白蛋白≤30 g/L)、吸烟史、吸烟时间≥20年、术中喉返神经损伤是食管癌并发肺部感染的危险因素(P<0.05)。结论食管癌术后并发肺部感染的危险因素较多,在治疗食管癌的手术中应引起广大医生的重视,从而采取积极的措施进行预防和治疗。     

肋间神经冷冻在胸外科术后镇痛作用的临床研究

目的探讨胸外科剖胸手术后肋间神经冷冻镇痛的效果.方法对100例胸外科开胸手术后患者进行随机分为肋间神经冷冻组和对照组各50例患者,按照视觉模拟评分法观察两组患者术后胸部疼痛和镇痛药物的使用情况,术后1、2、3周分别对每组患者行肺功能检查,客观评价肋间神经镇痛治疗在胸外科剖胸术后镇痛的作用.结果冷冻组术后镇痛效果满意,患者视觉模拟评分平均为2.01,对照组为8.13,两组比较有显著差异(P＜0.05).冷冻组患者术后肺功能恢复时间较快,在术后第1周与对照组相比有显著差异(P＜0.05),而术后第2周开始至第3周,两组患者肺功能比较无显著差异.结论肋间神经冷冻治疗对剖胸手术后镇痛效果明显,不会对肋间神经造成永久性损害,患者术后肺功能早期恢复,可有效降低肺部并发症,值得临床推广.     

电视胸腔镜辅助下小切口肺切除术

目的总结电视胸腔镜辅助下小切口肺切除术的方法.方法2002年1月至2004年12月我们对56例肺部包块患者进行了电视胸腔镜辅助下肺切除手术治疗,对患者的临床资料进行回顾性分析.本组患者包括肺楔形切除18例,肺叶切除23例,全肺切除15例;中转开胸手术2例.结果全组手术患者均安全度过围手术期,无手术死亡病例,与常规开胸手术比较,具有创伤小、术后恢复快的优点.结论电视胸腔镜下小切口肺切除术有其严格的手术指征,还不能完全替代常规开胸手术,但只要指征明确,手术操作得当,在胸外科的常规手术中优势明显.     

胸部硬膜外阻滞在心脏开胸手术术后镇痛的临床研究

目的探讨心脏开胸手术中采用胸部硬膜外阻滞（TEA）术后镇痛的效果及不良反应。方法30例拟行心脏开胸手术的患者分为观察组和对照组。观察组采用硬膜外腔术后镇痛,对照组采用阿片类药物镇痛。观察术前（T1）、术后拔管完全清醒时（T2）、术后24h（T3）、48h（T4）两组患者血压、脉搏血氧饱和度（SpO2）、平均动脉压（MAP）、呼吸频率（RR）、心率（HR）变化及可察觉的不良反应。结果两组患者在T1时点血压、MAP、HR、RPP值变化比较差异无统计学意义（P〉0.05）,在T2、T3、T4时点观察组的SBP、DBP、MAP、HR、RPP值显著低于对照组（P〈0.05）。而两组患者在各时点SpO2、RR比较差异无统计学意义（P〉0.05）。两组术后均有患者出现恶心、呕吐等症状,观察组有2例（13.3%）患者于术后出现S-T段改变,对照组患者术后有12例（80.0%）患者出现S-T段改变。结论开胸手术采用TEA术后镇痛效果确切,不良反应少,具有重要的临床价值。     

全腔镜与开放食管癌切除术对患者术后早期肺功能影响比较

目的 探讨全腔镜与开放食管癌切除手术对患者术后早期肺功能的影响.方法 将61例食管癌手术患者随机分为全腔镜组(胸腹腔镜联合行食管癌切除手术组,32例)及开放组(经右胸、上腹及左颈三切口食管癌切除手术组,29例).分别于术前1d,术后第5及10天测定肺通气功能1秒用力呼气容积(FEV1)、用力肺活量(FVC)及血气分析,记录术后第1～5天疼痛评分及肺部并发症发生情况.结果 两组术前FEV1、FVC及血气分析差异均无统计学意义(均P＞0.05).术后第5及10天,两组FEV1及FVC均有不同程度的降低,以实测值/术前预计值作为比较参数,全腔镜组降低程度均小于开放组(均P＜0.05),术后第10天血氧分压(PaO2)及动脉血氧饱和度(SaO2)全腔镜组均高于开放组(均P＜0.05).术后第1～5天疼痛评分全腔镜组均低于开放组,其中术后4d内疼痛评分差异均有统计学意义(均P＜0.05).全腔镜组术后肺部并发症发生率低于开放手术组(P＜0.05).结论 胸腹腔镜联合行食管癌手术对患者术后早期肺功能影响相对较小,能降低术后肺部并发症发生率.     

Analgesia for day surgery.

OBJECTIVE: To review current and potential analgesic techniques in day surgery, with particular regard to their pharmacology. DATA SOURCES: Recent articles on analgesia for surgery and day surgery were retrieved from Index Medicus for 1988-1990. Pharmacokinetic data were collated from recent textbooks and articles. DATA SYNTHESIS: The reviewed information is integrated with a pharmacological approach and personal experience with the use of postoperative analgesia. CONCLUSIONS: Combination analgesia therapy is the best approach for postoperative analgesia for day surgery. The usefulness of preoperative blockade of the pain sensation which limits activation of the central pain pathway and decreases analgesic requirements, is also emphasised. Examples of measures for relief of mild, moderate and severe pain are given.