多功能充气式胸带对微创肺切除术后患者肺功能恢复的分析

当前,微创肺癌根治术以其创伤小、恢复快的优点逐渐成为肺疾病首选的手术方式,主要适用于肺恶性肿瘤、肺结节、肺结核等疾病[1-2]。由于手术对肺组织的挤压、挫伤,必然会引起炎性物质渗出导致疼痛加剧,从而影响肺通气及换气功能,甚至产生肺不张、呼吸系统感染和呼吸衰竭等并发症[3-5]。因此,术后肺功能的快速恢复是我们亟待解决的问题。伤口疼痛、咳嗽困难、难于下床活动是影响肺功能恢复的主要因素[6]。     

影响肺癌术后肺功能恢复的相关因素分析

<正>肺癌手术创伤较大,无论是行微创手术还是开胸手术,术中手术操作、麻醉单肺通气等特殊情况,常需要挤压肺组织,牵拉刺激肺门及支气管,反射性引起呼吸道分泌物增加、肺组织挫伤,不同程度引起患者肺通气及换气功能不全,同时术后发生肺部并发症也会造成不同程度的通气和换气功能障碍,影响患者肺功能的恢复。以下为影响肺癌术后肺功能恢复的相关因素分析。一、肺癌术后肺功能恢复的相关因素1.术前因素(1)一般情况:1年龄:研究表明:随着年龄的     

振荡排痰在胸腔镜治疗肺癌合并慢性阻塞性肺疾病术后并发症中的临床应用

<正>胸腔镜技术是近年来应用于胸外科手术中的一种新技术,其在高清晰度电视显像系统直视下,经胸壁切口将手术操作系统置入胸腔,诊断和治疗胸部疾病,该手术有切口小、损伤小、恢复快等优点,在临床上得到了广泛的应用[1]。原发性支气管肺癌(简称肺癌)和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者具有共同的危险因素吸烟,所以很多肺癌患者在胸腔镜术前肺功能评估中确诊合并有COPD。COPD患者由于纤毛功能低,在胸腔镜术后往往会发生肺部感染、肺不张等并发症[2-3],这就增加了患者     

76例单肺叶切除术术后早期肺功能的变化研究

目的比较完全胸腔镜下单肺叶切除术和传统开放式单肺叶切除术对肺癌患者术后早期肺功能变化的影响。方法选取2014年1月至2014年6月在安徽医科大学第一附属医院普胸外科行单肺叶切除术肺癌患者共76例,按照手术方法分为传统开放手术组40例及胸腔镜手术(VATS)组36例,通过术后第7天和术后第30天肺功能检查指标及血气分析指标比较单肺叶切除术中传统开放术式和胸腔镜术式对患者术后早期肺功能变化的影响。结果单肺叶切除术后早期肺功能下降明显;术后第7天胸腔镜组反映肺功能指标(VCmax、MVV、Pa O2、Pa CO2、SO2%)优于开放组,差异有统计学意义(P0.05);术后第30天胸腔镜组反映肺功能指标(VCmax、MVV、Pa O2、Pa CO2、SO2%)优于开放组,差异有统计学意义(P0.05)。结论单肺叶切除行胸腔镜手术有利于患者术后早期肺功能更快速、更有效的恢复。     

胸腔镜手术对老年肺癌合并COPD患者肺功能及血清PCT、hs-CRP水平的影响

目的探讨胸腔镜手术治疗对老年肺癌合并慢性阻塞性肺疾病(COPD)患者肺功能及血清降钙素原(PCT),超敏C反应蛋白(hs-CRP)水平的影响。方法选取胸外科收治的208例肺癌合并COPD患者的临床资料,其中128例行全胸腔镜手术治疗(观察组)和80例行开胸手术治疗(对照组)。比较两组围术期各项指标、肺功能、术后并发症及血清PCT、hs-CRP水平。结果观察组围术期指标(手术时间、术中出血量、术后引流量)明显低于对照组(P0. 05),淋巴结清扫数目两组间差异无统计学意义(P0. 05);观察组第1秒用力呼气容积占预计值百分比(FEV1%)、用力肺活量(FVC)、每分钟通气量(MV)、肺一氧化碳弥散量(DLCO)与对照组比较差异均有统计学意义(P0. 05);观察组术后并发症(肺部感染、切口感染、心律失常、胸腔出血、肺不张)发生率均明显低于对照组(P0. 05)。结论胸腔镜手术治疗老年肺癌合并COPD患者,术后创伤小,肺功能恢复好,并发症发生率低,同时降低血清炎症因子PCT、hs-CRP的表达水平。     

低肺功能老年肺癌患者的外科治疗及围手术期处理

目的探讨低肺功能老年肺癌患者外科治疗的适应证、手术方式及围手术期处理。方法回顾性分析手术治疗的42例70岁以上低肺功能肺癌患者的临床资料。按其肺功能分为轻度、中度及重度呼吸功能障碍三组，比较术后呼吸衰竭、心律失常等并发症的发生率，重点观察重度肺功能障碍组。结果重度呼吸功能障碍组术后死亡1例，其呼吸衰竭及心律失常等并发症的发生率高于轻度、中度呼吸功能障碍组。结论手术技术的提高和术后呼吸机辅助呼吸的应用，对低肺功能老年肺癌患者可相对扩大手术适应证。     

术前肺功能对肺切除术术后并发症及术后肺功能的预测

目的观察肺切除手术患者术前、后肺功能演变特征,探讨术前肺功能指标对患者术后并发症和术后肺功能的预测能力。方法对115例肺切除手术患者进行术前常规肺功能及运动心肺功能检测,术后3个月行肺功能复查;追踪患者1个月内术后心肺并发症(PPC)的发生情况。结果28例手术患者出现PPC(24.35%);有、无PPC组间比较有差异的肺功能指标为:FVC%pred、FEV1%pred、VO2m ax%pred、WRm ax%pred、VO2/HR%pred;术后肺通气功能、运动心肺功能与术前比较有不同程度下降;术后肺功能实测值与公式法预计的术后肺功能值比较差异有显著性。结论术后肺功能损害主要是限制性肺通气功能障碍,运动心肺功能亦有下降。建立预测PPC及术后肺功能的回归方程,能更准确地评估患者的手术耐受力。     

中老年肺癌患者术后近期心肺并发症与术前肺功能的关系

我们自１９９４年８月～１９９５年８月对８６例中老年肺癌患者围术期肺功能进行观察，以探讨中老年肺癌患者术后近期心肺并发症与术前肺功能的关系，结果如下。对象与方法病例选择：８６例经本院胸外科手术治疗、术后病理证实肺癌的男性患者，平均年龄６４岁（５０～７８...     

双源CT定量成像技术对肺癌患者术后肺功能改变的应用价值

目的研究双源CT定量成像技术对肺癌患者术后肺功能改变的临床应用价值。方法以2015年2月-2018年2月在我院接受单操作孔胸腔镜下肺叶或全肺切除治疗的肺癌患者132例为观察对象。术前7d以及术后3个月对所有患者进行常规肺功能检测,同时采用双源CT定量成像技术对患者进行扫描,分别测量患者不同肺叶、单侧肺以及全肺的肺容积以及肺密度值等指标水平。分析双源CT定量成像技术扫描所获得的肺容积水平和患者术前、术后肺功能指标的相关性。此外,分析术前CT肺功能预测值和术后肺功能实测值的相关性。结果右中叶、右上叶、右下叶、左下叶、左上叶的吸气容积呈逐渐升高趋势,且经单因素方差分析可得:各肺叶之间对比差异均有统计学意义(均P0.05)。吸气相容积、呼气相容积、肺容积差、吸气相肺密度、呼气相肺密度、肺密度差与患者手术前后的肺总量、残气量、FVC、FEV_1、FEV_1/FVC均存在密切相关(均P0.05)。不同手术部位术前CT肺功能预测值和术后肺功能实测值具有较高的相关性,且相关系数最高为0.95。结论双源CT定量成像技术应用于肺癌患者术后肺功能改变中的效果较佳,有利于精确评估肺癌患者接受手术治疗后的肺功能变化状况,值得临床推广应用。     

目标锻炼对单孔胸腔镜肺叶切除患者围术期快速康复的影响

<正>胸腔镜下肺叶切除术是胸外科手术快速康复外科的重要组成部分,与传统开胸手术相比,该术式具有创伤小、术后恢复快等优点,对于病变限于单一肺叶内而需要行单个肺叶切除的患者提供了良好的手术方式[1-2]。随着胸部微创手术的飞速发展,胸腔镜相关器械及操作技术的应用也越来越普遍,单孔胸腔镜在胸外科的应用范围也越来越广[3]。单孔胸腔镜肺叶手术的切口长度和数量能够使患者肌肉、神经、血管的损伤显著减轻,同时也减轻了术后疼痛程度和胸壁麻木程度[4]。为做好单孔胸腔镜肺叶切除术患者围手术期护理     

Ageing and lung function

Studies of lung function have largely ignored the elderly. This paper reviews what is known of the decline in measurements of lung function, and focuses on reduced elastic recoil as a key to these changes. Independent anthropometric changes which may affect lung function with advancing years are also discussed.     

Fat emulsions and lung function

IVFE infusion can impair lung function in healthy adults, premature infants, and adults with pre-existing lung injury, and in experimental animals with acute injury. Although all observed IVFE-related lung dysfunction was initially attributed to the temporally associated hyperlipemia, this explanation may in fact be correct only with fat overload syndrome. When serum triglyceride levels are in a more appropriate range, all subsequent studies have shown the same alterations in lung function unrelated to triglyceride increases and indomethacin-related blocking of lung function impairment, despite comparable serum triglyceride increases. Furthermore, our studies with Liposyn demonstrated the most significant increases in serum triglyceride levels, but the smallest PaCO2 and PaO2 changes. In general, the lung function abnormalities associated with IVFE infusion have thus been caused by increases in VA/Q inequalities. Although elucidation of the relationship between IVFE-related increased PG production and secondary VA/Q changes may be of significant physiologic import, the PaO2 and PaCO2 changes even with pre-existing lung injury have generally not been of sufficient magnitude to be of much clinical significance. The IVFE-related increases in plasma PG concentrations may, however, still have significant nonpulmonary clinical effects related to known or postulated consequences of increased plasma PG concentrations, including effects on ductus arteriosus patency, retinal and cerebral blood flow, and immune competence.     

Socioeconomic status and lung function

Poverty is a major social problem in the United States and throughout much of the world. Poverty and the broader term socioeconomic status (SES) are important determinants of overall health status and many pulmonary diseases. The purpose of this study was to review the medical literature from the past 20 years addressing the relationship between SES and lung function in both children and adults. There is a significant negative correlation between lung function (primarily FEV1 and FVC) and SES. This relationship exists even after adjusting for smoking status, occupational exposures, and race. The magnitude of the effect of low SES on lung function is variable, but FEV1 reductions of >300 mL in men and >200 mL in women have been reported. SES is an important determinant of lung function and an underrecognized contributor to pulmonary disease.     

Measuring lung function in infancy

Although the earliest reliable lung function tests in infants were performed as long as 40 years ago, there has only recently been a growth in this area, as simpler methods and better equipment and IT resources have been developed. Exciting information is accumulating about the normal physiology and pathology of the infant lung. Many basic questions are still unanswered and the ability to perform these tests remains confined to a few specialized centres. To co-ordinate the development of ILFT and establish standardization in a number of areas including measurement conditions, equipment specifications, methodology protocols and data analysis, international collaboration is necessary between the teams working in this field (Table 5). Collaborative groups are currently addressing these issues and are also developing recommendations regarding the design of randomized clinical trials, multi-centre studies and research agendas. Infant lung function testing remains primarily a research tool. Our aim should be not only to refine and develop the techniques of physiological measurement but to apply ILFT to the objective study of respiratory illness in infants in the clinical setting so as to aid in the prevention and treatment of these common, debilitating and costly diseases.