老年患者腹部手术对呼吸功能的影响

目的评价老年患者腹部手术后呼吸功能的变化及其影响因素.方法60岁以上(包括60岁)择期腹部手术患者35例,分别在手术前和手术后第1、3、5、10d,应用脉冲振荡肺功能测定仪(IOS)测定最大肺活量(VCmax);用力肺活量(FVC)、第1s用力呼气容积(FEV10)、FEV1.0/FVC、最大通气量(MVV);呼气流速峰值(PEF)、用力肺活量为25%、50%和75%时的气流量(FEF25、FEF50、和FEF7s);中心气道阻力(Rc)、周边气道阻力(Rp)、共振频率(Fres)、呼吸总阻抗(Zrs)以及不同振荡频率下的通气阻力5赫兹时呼吸阻力(R5)、20赫兹时呼吸阻力(R20)和5赫兹时呼吸电抗(X5).结果与手术前相比,手术后第1、3、5dVCmax、FVC、FEV10、MVV、PEF、FEF25、FEF50均明显降低(P<0.01),并以手术后第1d最为明显,手术后第1dFres、Zrs和R5明显增加(P<0.01或0.05),而R20和R5不变.年龄70～79岁组较60～69岁组患者手术前和手术后第1、3、5dFEF10、MVV、PEF均显著降低(P<0.01或0.05);手术前ASA≥Ⅱ级患者肺通气功能(PEF、MVV)明显低于ASAⅠ级患者(P<0.05或0.01),而麻醉类型、手术部位、伤口疼痛程度、手术时间、术后胃肠减压持续时间及患者体重系数对手术后肺通气功能无明显影响(P>0.05).结论老年患者腹部手术后呼吸功能的改变主要发生于手术后早期,除表现为限制性通气障碍外,还存在阻塞性通气障碍,其改变程度与患者的年龄和术前伴随疾病有关.

A prospective study of the effects of abdominal surgery on postoperative pulmonary function in aged patients

Objective To evaluate the changes in pulmonary function in old patients undergoing abdominal surgery and the relevent factors. Methods Thirty-five consecutive patients aged over 60 years (including 60 years) undergoing elective abdominal surgery were studied. The patients were divided into 3 age groups: 60-69 yr, 70-79 yr and 80-86 yr. ASA status, types of anesthesia and surgery, and intensity of postoperative pain were recorded. Pulminary function was assessed 1-3 days before operation and on the 1st,3rd, 5th and 10th postoperative day using impulse oscillometry (IOS) . The respiratory parametera measured included maximal vital capacity (VCmax); ventilatory function: forced vital capacity (FVC),forced expiratory volume in one second(FEV1.0 ), FEV1.0/FVC, maximal voluntary ventilation(MVV);flow-volume index: peak expiratory flow(PEF), flow at 25%, 50% and 75% of forced vital capacity (FEF25, FEF50 and FEF75 );central airway resistance(Rc), peripheral airway resistance(Rp), frequency of resonance (Fres) and total pulmonary impedance. Results The study comprised 29 male and 6 female. Age ranged between 60-86 yr, with a mean age of (70.17±6.04) yr. Body weight averaged(58.69+9.64) kg. Surgery was performed on liver, gallbladder, stomach, colon and rectum. The average duration of operation was (171±96)min. Preoperative pulmonary function tests showed that aged people suffered from reduced ventilatory function to some extent. Patients in 70-79 age group had more marked decrease in ventilatory function than patients in 60-69 age group. But type of anesthesia and operation, intensity of pain in the wound, duration of operation and patients' body weight had little effect on postoperative ventilatory function. VCmax, FVC, FEV1.0, MVV, PEF, FEF25, and FEF50 decreased significantly on the lst,3rd and 5th postoperative day as compared with the baseline values obtained before operation. The decrease was most obvious on the 1st postoperative day, then the respiratory parameters were gradually improving during the postoperative period. But even on the 10th day the parameters were not yet restored to the preoperative values. Conclusions Significant changes in the pulmonary function after abdominal surgery occur in the early stage following the operations and involve not only restrictive but also obstructive ventilatory processes. The patients' age and preoperative physical status affect the changes.Key Words] Aged; Abdomen; Surgical procedures, operative; Respiratory function tests