【摘要】 目的探讨全胸腔镜肺叶切除对腹型肥胖低肺功能肺癌患者术后心肺功能的影响。方法 2013年7月~2014年6月对23例腹型肥胖伴低肺功能肺癌行全胸腔镜肺叶切除术,观察术后1周内心肺并发症,术前2 d,术后第3、7天,1.5、3、6个月行肺功能检查及登楼试验,评价心肺功能。结果术后心肺并发症发生率39.1%(9/23)。术后第3天较术前FVC[(1.83±0.45)L vs.(2.70±0.68)L,q=7.936,P<0.05]、FEV1.0[(1.05±0.29)L vs.(1.75±0.25)L,q=9.745,P<0.05]、FEV1.0/FVC[(53.3±7.6)%vs.(70.2±6.0)%,q=9.902,P<0.05]、MVV[(55.3±14.9)L/min vs.(86.8±16.5)L/min,q=9.279,P<0.05]、FRC[(1.50±0.27)L vs.(2.25±0.35)L,q=8.920,P<0.05]明显下降,术后第7天较术前FVC[(2.07±0.53)L vs.(2.70±0.68)L,q=5.747,P<0.05]、FEV1.0[(1.35±0.31)L vs.(1.75±0.25)L,q=5.568,P<0.05]、FEV1.0/FVC[(57.6±7.4)%vs.(70.2±6.0)%,q=7.382,P<0.05]、MVV[(66.3±15.8)L/min vs.(86.8±16.5)L/min,q=6.038,P<0.05]、FRC[(1.68±0.35)L vs.(2.25±0.35)L,q=6.779,P<0.05]下降明显;术后第7天与第3天比较,FEV1.0[(1.35±0.31)L vs.(1.05±0.29)L,q=4.176,P<0.05]、MVV[(66.3±15.8)L/min vs.(55.3±14.9)L/min,q=3.240,P<0.05]有统计学差异,在短期内恢复;术后1.5月较术后第3、7天FVC、FEV1.0/FVC、MVV明显好转(P<0.05),与术后3、6个月无统计学差异(P>0.05),肺功能趋于稳定;FVC、FEV1.0、FEV1.0/FVC、MVV术后6个月与术前比较无统计学差异(P>0.05),表明肺功能已恢复到术前水平。登楼试验显示术后第7天仅2例(8.7%)能坚持到5楼,且HR明显升高、登楼时间延长及Sp O2下降均≥5%;术后1.5月登楼成功例数与术前无差异(P>0.05),术后3个月仅登楼时间较术前有明显差异(P<0.05)。结论腹型肥胖低肺功能肺癌患者行全胸腔镜肺叶切除术后1周对心肺功能影响明显,注意加强围手术期管理,1.5月后心肺功能逐渐代偿,恢复满意。更多还原

【Abstract】 Objective To observe effects of complete video-assisted thoracoscopic lobotomy on heart and lung functions in abdominal obesity patients with lower lung function lung cancer. Methods A total of 23 cases of abdominal obesity patients with lower lung function lung cancer underwent complete video-assisted thoracoscopic lobotomy from July 2013 to June 2014. The heart and lung complications after operation in one week were observed,and lung function and climbing stair tests were conducted on the 2nd,3rd and 7th postoperative day,as well as at 1. 5,3,and 6 months after operation,respectively. Results After the operation the incidence of heart and lung complications was 39. 1%( 9 /23). On the 3rd postoperative day,the FVC [( 1. 83 ± 0. 45) L vs.( 2. 70 ± 0. 68) L,q = 7. 936,P < 0. 05],FEV1. 0[( 1. 05 ± 0. 29) L vs.( 1. 75 ± 0. 25) L,q = 9. 745,P < 0. 05],FEV1. 0/ FVC[( 53. 3 ± 7. 6) % vs.( 70. 2 ± 6. 0) %,q = 9. 902,P < 0. 05],MVV [( 55. 3 ± 14. 9) L/min vs.( 86. 8 ± 16. 5) L/min,q =9. 279,P < 0. 05],and FRC [( 1. 50 ± 0. 27) L vs.( 2. 25 ± 0. 35) L,q = 8. 920,P < 0. 05] obviously decreased as compared with preoperative levels. On the 7th postoperative day,the FVC [( 2. 07 ± 0. 53) L vs.( 2. 70 ± 0. 68) L,q = 5. 747,P < 0. 05],FEV1. 0[( 1. 35 ± 0. 31) L vs.( 1. 75 ± 0. 25) L,q = 5. 568,P < 0. 05],FEV1. 0/ FVC [( 57. 6 ± 7. 4) % vs.( 70. 2 ± 6. 0) %,q = 7. 382,P < 0. 05],MVV [( 66. 3 ± 15. 8) L / min vs.( 86. 8 ± 16. 5) L / min,q = 6. 038,P < 0. 05 ],and FRC [( 1. 68 ± 0. 35) L vs.( 2. 25 ± 0. 35) L,q = 6. 779,P < 0. 05] obviously decreased than those in preoperation. Comparison between 7th and 3rd postoperative day showed the FEV1. 0[( 1. 35 ± 0. 31) L vs.( 1. 05 ± 0. 29) L,q = 4. 176,P < 0. 05] and MVV [( 66. 3 ± 15. 8)L / min vs.( 55. 3 ± 14. 9) L / min,q = 3. 240,P < 0. 05] restored rapidly. At the 1. 5 postoperative months,the FVC,FEV1. 0/ FVC,MVV were improved significantly than those on the 3rd and 7th postoperative day( P < 0. 05) and had no statistical differences as compared with 3 and 6 postoperative months( P > 0. 05),when the lung functions were stabilized. At the 6 postoperative months,the FVC,FEV1. 0,FEV1. 0/ FVC,and MVV had no significant differences compared with preoperation( P > 0. 05),representing a full recovery of lung functions. Climbing stair tests showed on the 7th postoperative day only 2 cases could climb to the fifth floors( 8. 7%),with the heart rate significantly increased,climbing time significantly prolonged and Sp O2 decreased by more than 5%. At the 1. 5 postoperative months,the number of successful climbing cases had no statistical differences compared with preoperation( P >0. 05); at the 3 postoperative months,only the climbing time was longer than preoperation with statistical differences( P < 0. 05).Conclusions Within 1 week after complete video-assisted thoracoscopic lobotomy,the heart and lung functions were effected obviously in abdominal obesity patients with lower lung function lung cancer,and perioperative management should be strengthened. After 1. 5postoperative months the heart and lung functions will be compensated with satisfactory recovery.更多还原