高龄低肺功能食管癌围手术期处理的临床研究  

Study on perioperative treatment in aged patients with esophageal carcinoma and lung function impairment

作　　者：邹济华[1] 梁翔[1] 段德溥[1] 孙德魁[2] 吴松昌[2] 

机构地区：[1]上海解放军第455医院胸心外科 [2]上海胸科医院胸外科,上海200052

出　　处：《临床和实验医学杂志》2008年第6期29-30,共2页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨高龄伴肺功能损害的食管癌患者围手术期呼吸道管理、麻醉与手术方式的选择及术后呼吸机的应用。方法67例70岁以上食管癌患者均有不同程度肺功能减损,依据最大通气量(MVV)和一秒钟呼气肺活量(FEV1)占预计值百分比分为3组:轻度损害组13例,中度损害组48例,重度损害组6例。对比研究3组患者术后呼吸衰竭、心律失常发生情况及围手术期处理特点。结果各组无手术死亡。手术后并发症重度损害组6例同时发生呼吸衰竭及房颤,术后第3d行气管切开,分别于机械通气后第13d、17d脱机;中度损害组中11例病人出现心律失常(室性早搏3例,房颤8例),呼吸衰竭2例,延长机械通气时间至第11d脱机;轻度损害组中3例病人出现心律失常(房颤1例,心动过速2例),无呼吸衰竭。重度损害组发生呼吸衰竭和心律失常发生率明显高于轻度损害组,差异具有显著性(P<0.05)。结论由于手术技术的不断改进和提高,术后呼吸机机械通气的广泛应用,对高龄伴肺功能损害的食管癌患者,相对放宽手术适应证,加强围手术期处理,仍能取得较为满意的治疗效果。Objective To investigate the indication of surgical treatment, choice of operation procedure and application of post -operation respirator in aged patients suffered from esophageal carcinoma with low pulmonary function. Methods According to pre - operation maximal voluntary ventilation （ MVV ）, 67 over - 70 - year - old patients suffered from esophageal carcinoma with low pulmonary function undergoing esophagectomy were divided into 3 groups： 13 patients（ MVV 80% - 71%, FEVI 70% - 61% ）in group 1,48 patients（ MVV 70% - 51%, FEV 160% - 41% ） in group 2 and 6 patients（ MVV 50% -21%, FEVI 〈40% ） in group 3. The occurrence of respiratory failure and arrhythmia was compared among patients in these 3 groups. Results There was no death occurred in all groups. Respiratory failure and auricular fibrillation were happened in 6 patients of group 3 and in 2 patients（FEV1/FVC 〈45% ） of group 2. There were 3 and 11 patients suffered from arrhythmia in group 1 and 2 respectively. No one had respiratory failure. Conclusion With the improvement of surgical techniques and application of post - operation respirator, the indication for surgical treatment could be relatively expanded, and perioperative care should be strengthened. The therapeutic result of surgical treatment in aged patients with esophageal carcinoma and low pulmonary function is still satisfactory.

关 键 词：高龄 肺功能损害 食管癌 围手术期 呼吸机 

分 类 号：R735.1[医药卫生—肿瘤]