肺功能不全患者肺癌切除术的术前评估

肺癌切除术给早期肺癌患者提供了最佳的治愈机会,但是对于肺功能不全的肺癌患者行手术切除,可能会出现严重的术后并发症,甚至死亡,所以术前的评估很重要。应从年龄,一般情况,肺功能和运动能力这4个方面进行评估,以决定肺癌患者是否能耐受肺癌切除术。     

The prognostic value of pre-operative predicted forced vital capacity in corrective spinal surgery for Duchenne's muscular dystrophy

The majority of patients with Duchenne's muscular dystrophy require corrective spinal surgery for scoliosis to maintain seated balance and to slow the progression of respiratory compromise, thereby facilitating nursing and enhancing their quality of life. Traditionally patients with a pre-operative forced vital capacity (PFVC) of 30% or below predicted have been denied this surgery as it was thought that the incidence of postoperative complications was unacceptably high. We present data collected prospectively from 45 consecutive operations undertaken in our unit. These cases indicate that there is no clinically significant difference in operative and postoperative outcomes between patients with PFVC > 30% and < or =30%. However, the routine postoperative use of mask ventilation to facilitate early tracheal extubation is vital.     

Impact of burn contractures of chest wall and their surgical release on pulmonary function

BackgroundExtensive burn scars and contractures are likely to restrict the movements of the chest wall which may affect the pulmonary ventilation by restricting its expansion during inspiration. We designed this study to evaluate the effect of burn contractures of chest wall on pulmonary function and to estimate the effect of contracture release on pulmonary functions in patients with compromised PFT.MethodsPulmonary function tests (PFT) of 20 patients having chest wall contractures involving more than 50% of the chest circumference were studied. Restrictive lung disease was defined as forced vital capacity (FVC) value less than 80% of predicted normal for the age, weight, and height of that patient. Patients with a restrictive pattern on PFT were subjected to the surgical release of the contracture. PFT was repeated one month after the surgery which was compared with the initial report.ResultsOf the 20 patients included in the study, 5 (25%) patients had a restriction pattern on PFT. 1 patient had a mild restriction, 2 patients had moderate restriction and 2 patients had a severe restriction of pulmonary function. The mean duration of contracture was 58.2 ± 15.75 months in patients with a pulmonary restriction as compared to 29.87 ± 6.21 months in patients with a normal PFT (p = 0.001). All patients having a restrictive pattern on PFT had contracture involvement of >75% of the chest wall circumference (p = 0.0036). The mean forced vital capacity (FVC) increased from 1.94 L preoperatively to 2.11 L after surgical release of the contracture (p = 0.047). However, the restriction pattern in PFT did remain.ConclusionLong standing chest wall contractures and contractures involving >75% of the chest circumference are likely to cause a restrictive pattern on PFT. Any significant improvement of pulmonary function after surgical release of the contracture is unlikely.