老年患者腹部手术对呼吸功能的影响  

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

作　　者：张伟[1] 曹俊[2] 蒋永新[2] 鲍鲁红[2] 楼旭军[2] 戴晓敏[2] 

机构地区：[1]上海第二医科大学附属第九人民医院,200011 [2]上海市第一人民医院

出　　处：《中华麻醉学杂志》2001年第4期213-216,共4页Chinese Journal of Anesthesiology

摘　　要：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　 6 0岁以上 (包括 6 0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 (FEV1 0 )、FEV1 0 /FVC、最大通气量 (MVV) ;呼气流速峰值 (PEF)、用力肺活量为 2 5 %、5 0 %和 75 %时的气流量 (FEF2 5、FEF50 、和FEF75) ;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 )、2 0赫兹时呼吸阻力 (R2 0 )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、FEV1 0 、MVV、PEF、FEF2 5、FEF50 均明显降低 (P <0 0 1) ,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 0 1或0 0 5 ) ,而R2 0和R5不变。年龄 70～ 79岁组较 6 0～ 6 9岁组患者手术前和手术后第 1、3、5dFEF1 0 、MVV、PEF均显著降低 (P <0 0 1或 0 0 5 ) ;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 0 5或 0 0 1) ,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?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(FEV 1 0 ), FEV 1 0 /FVC, maximal voluntary ventilation(MVV); flow volume index: peak expiratory flow(PEF), flow at 25%,50% and 75% of forced vital capacity (FEF 25 ,FEF 50 and FEF 75 );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, FEV 1 0 ,MVV,PEF,FEF 25 , and FEF 50 decreased significantly on the 1st,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 respira

关 键 词：老年人 腹部外科手术 呼吸功能试验 

分 类 号：R614[医药卫生—麻醉学]