合并慢性阻塞性肺疾病对胸部手术的影响

目的探讨合并慢性阻塞性肺疾病(CPOD)对胸部手术的影响因素及围手术期处理。方法对35例合并慢性阻塞性肺疾病的开胸病人临床资料进行分析,术前检测MVV<50%32例,<40%18例,FEV1<50%30例,<40%22例,FVC<60%26例,<50%11例,肺癌16例,食管、贲门癌19例。结果全组手术成功率在80%以上,全组无手术中死亡,并发急慢性呼吸衰竭各4例,死亡6例。死亡病例中,MVV均<50%,其中4例<40%;FEV1均<50%。结论对合并慢性阻塞性肺疾病适于胸部手术的病人应确定肺功能界限值;FVC在60%以上,MVV和FEV1两项中至少有一项在40%以上。另外,必要的术前准备、重视麻醉及术中操作,术后呼吸管理和治疗,大部分合并慢性阻塞性肺疾病的病人是能够耐受胸部手术的。

Influence of patients associated with chronic obstructive pulmonary on the risk of intrathoracic surgery.

Objective To evaluate the influence of patients associated with chronic obstructive pulmonary on the risk intrathoracic operation.Methods 35patients associated with chronic obstructive pulmonary undergoing intrathoracic operation were chosen for study.Their surgical pathology included lung carcinoma in16cases and esophageal and gastric cardial carcinoma in19.Pulmonary functioned tests MVV<50%in32patients,<40%in18;FEV1<50in30patients and40%in22;FVC<60%in26patients,<50%in11.Results Postoperative acute and chronic respiratory failure occurred in4patients respectively,resulting in6deaths giving a mortality rate of17%.Conclusions The data indicate that for patients associated with chronic obstructive pulmonary,criteria for intrathoracic operation should be critically scrutinized.Their FVC should be higher than60%and MVV or FEV1higher than40%.Cautious preoperative preparations,good choice and practice anesthesia,gentle operative technique with least amount of pulmonary trauma,thorough preoperative toileting of the respiratory tract and early treatment of pulmonary complications may help the patients survive the intrathoracic operation.