脉冲振荡肺功能_脉冲振荡法与肺通气功能在外科手术中的对比研究

　　[摘要] 目的 探讨脉冲振荡法和肺通气功能在外科术前的临床应用。 方法 选择100例外科术前患者与正常对照者100例行常规肺通气功能及脉冲振荡法检测，观察VC、FVC、FEV1%、FEV1/FVC、VMAX、MVV；Fres、Zrs、R5、R20、R35、X5、Rc、Rp。 结果 手术前常规肺通气功能检测指标在正常范围。仅MVV轻度减损（75.35±20.50）。VC、FVC、FEV1%、FEV1/FVC、VMAX与正常组比较，差异有高度统计学意义（P ＜ 0.01）。说明预手术患者肺通气功能无明显障碍，完全能耐受麻醉与手术风险。但与正常组存在明显差异。Zrs、R5、R20、R35、X5、Rc、Rp外科组指标明显异常，与对照组差异有高度统计学意义（P ＜ 0.01），说明需要外科手术患者总气道黏性阻力（Zrs）异常、周边及中心气道黏性阻力升高（R35、Rp、Rc异常），周边弹性阻力升高（X5异常）。 结论 脉冲振荡肺功能测定比常规肺通气功能在外科患者更敏感。总气道黏性阻力、周边及中心气道黏性阻力、周边弹性阻力在外科患者术前升高。
　　[关键词] 肺通气功能；脉冲振荡法；外科患者；手术
　　[中图分类号] R619 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0063-02
　　
　　The clinical application of impulse oscillometry and pulmonary ventilation function in surgical patients before operation
　　YE Jiangfeng 1 YU Lili2 SUN Wei3 YUAN Minghui1 MENG Yulin1
　　1.The 2nd Medicine Department, the 188th Hospital of PLA, Chaozhou 521011, China; 2. Information Center, The Ji"nan General Hospital of PLA, Ji"nan 250000, China; 3.The Urumqi General Hospital of PLA, Urumqi 830000, China
　　[Abstract] Objective To explore the clinical application of impulse oscillometry in surgical operations. Methods Compared the parameters of pulmonary ventilation function and impulse oscillometry in 100 surgical patients before operation with 100 healthy adults, VC, FVC, FEV1%, FEV1/FVC, VMAX, MVV; Fres, Zrs, R5, R20, R35, X5, Rc, Rp were observed. Results Datas of ventilation function were normal in surgical patients before operation, but MVV decreased slightly(75.35±20.50). Compared with control group, VC, FVC、FEV1%, FEV1/FVC, VMAX were different(P ＜ 0.01). There were normal pulmonary ventilation function in surgical patients before operation, which could experience risk of operation.. There were significant differences compared with healthy adults. The Zrs, R5, R20, R35, X5, Rc, Rp in surgical group was obviously abnormal, compared with control group, there were statistically significant differences(P ＜ 0.01). It declared that respiratory impedance(Zrs), center and peripheral viscosity resistance(R35, Rp, Rc), peripheral flexible resistance(X5) raise obviously before operation. Conclution IOS is more sensitive than pulmonary ventilation in surgical patients. Respiratory impedance(Zrs), center and peripheral viscosity resistance(R35, Rp, Rc), peripheral flexible resistance(X5) raise before operation.
　　[Key words] Pulmonary ventilation; Impulse oscillometry; Surgical patients; Surgery
　　外科手术对肺功能的影响主要是麻醉的影响和手术的影响。全身麻醉可抑制呼吸中枢，减少肺活量导致小气道陷闭，V/Q失调，抑制黏膜上皮细胞纤毛功能，其次麻醉期间肌肉松弛，卧位又限制了胸廓和膈肌运动，并使肺内血容量增加，导致胸廓和肺的顺应性降低，影响术后肺功能，此外麻醉中气管插管，呼吸道分泌物排出受阻会影响肺功能[1]。外科手术的影响尤其是开胸手术，肺脏处于开放性气胸，肺泡萎陷，通气面积锐减，肺循环阻力增加[2]，开胸手术对胸壁、支气管、肺组织的损伤会引起低氧、二氧化碳潴留。术后伤口疼痛，患者不敢呼吸、咳嗽，引起FVC下降，导致肺不张、肺炎等。V/Q下降，产生低氧。通过术前肺功能来处理围术期患者，并预测手术、麻醉风险及术后肺功能已成为预防和减少术后并发症不可缺少的手段之一[3]。