重度肺功能减退胸部肿瘤病人外科治疗及围术期管理

目的 探讨重度肺功能减退胸部肿瘤病人的外科治疗及围术期处理。方法 分析总结46例重度肺功能减退胸部肿瘤病人的手术经验及围术期管理经验。结果 术前肺功能检查均为重度肺功能减退，FEV1〈30％-50％、MVV〈30％～50％、FVC〈40％～60％。全组均经手术治疗，无手术中死亡，术后并发急性呼吸衰竭8例，死亡3例，死亡率为6．5％。结论 重视麻醉及术中操作，加强国术期管理，大部分重度肺功能减退胸部肿瘤病人是能够耐受胸部手术的。

Perioperative management of thoracic cancer patients associated with poor pulmonary function

Objective To review the experience of surgical management and perioperative treatment of the thoracic cancer patients associated with poor pulmonary function. Methods 46 thoracic cancer patients associated with poor pulmonary function undergoing intrathoracic operation were chosen for study. Their surgery pathology included lung carcinoma in 30 cases and esophageal and gastric cardial carcinoma in 16.8 cases developed acute respiratory distress syndrome (ARDS) after operation. Results 3 deaths giving 9 mortality rate of 6.5 % . Conclusion Strict and careful checkup before operation could lead to correct judgement of pulmonary function on the risk of intrathoracic surgery. Early diagnosis and treatment of ARDS is most important . Cautious preopera-tive preparations, good choice and practice of anesthesia, gentle technique with least amount of pulmonary trauma, thorough perioperative toileting of the respiratory tract and early treatment of pulmonary complications may help the patients survive the intrathoracic operation .