摘要
目的观察老年病人上腹部手术围术期呼吸力学的变化及低氧血症的发生情况 ,并探讨二者的关系。方法 6 0例上腹部手术病人按年龄分三组 ,每组 2 0例 ,ASAⅠ～Ⅲ级。Ⅰ组 75 ～89岁 ,Ⅱ组 6 0 ～74岁 ,对照组 4 5 ～5 9岁。监测食管内压、肺顺应性、呼吸功、P0 .1等 ,监测的时间点为术前、拔管前、拔管后 2 0min、术后 6h和 2 4h。并用 2 4h脉搏氧饱和度仪记录术后低氧血症发生情况。结果三组病人拔管后 2 0min呼吸力学改变最明显 ,以后逐渐恢复 ,恢复速度为Ⅰ组 <Ⅱ组 <对照组。Ⅰ组及Ⅱ组术后 2 4h内共发生低氧血症 9例 ,对照组无低氧血症发生。低氧血症组肺顺应性在术前、拔管后 2 0min、术后 6h和 2 4h明显低于无低氧血症组。结论上腹部手术病人在拔管后 2 0min呼吸力学变化最明显 ,老年人术后 2 4h呼吸力学仍不能恢复至术前水平。
Objective To observe the changes of perioperative respiratory dynamics and the incidence of post- operative hypoxemia in elderly undergoing elective upper abdominal surgery and their relationships. Methods Sixty patients undergoing upper abdominal surgery were divided into three groups, each group including 20 patients ASA Ⅰ～Ⅲ. Group Ⅰ aged 75～89, group Ⅱ aged 60～74, the third is control group and aged 45～59. The following measurements were performed perioperatively by Bicore CP100 respiratory monitor: esophageal pressure, pulmonary compliance, work of breathing and P 0.1. All measurements recorded at the time of preoperation, before ventilator weaning, 20 min after extubation, 6 h and 24 h postoperation. Meanwhile all patients were monitored by Nellcor pluse oximeter after extubation in 24 h. Results Compared with preoperation, respiratory dynamics changed markedly at 20 min after extubation in each group, then gradually recovered. There were 9 patients suffered post operative hypoxemia both in group Ⅰ and group Ⅱ,and no episode of postoperative hypoxemia in control group. In all elderly patients, pulmonary compliance was obviously lower in patients with postoperative hypoxemia than those without postoperative hypoxemia at the time of preoperation, 20 min after extubation, 6 h and 24 h postoperation. Conclusion Respiratory dynamics has obviously changed in patients undergoing upper abdominal surgery, especially at 20 min after extubation. Respiratory dynamics recovered slowly after operation in elderly and haven't completely restored to preoperative values at the time of 24 h postoperation. It is suggest that pulmonary compliance act as an indicator to evaluate postoperative hypoxemia incidence in elderly undergoing upper abdominal surgery.
出处
《上海第二医科大学学报》
CSCD
2004年第11期919-922,共4页
Acta Universitatis Medicinalis Secondae Shanghai
基金
上海市卫生局麻醉学重点学科 (9930 2 7)资助项目
关键词
老年人
围术期
呼吸力学
低氧血症
elderly
perioperative
respiratory dynamics
hypoxemia
