von Ungern-Sternberg B S, Regli A, Schneider M C, Kunz F, Reber A
Department of Anaesthesia, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland.
Br J Anaesth. 2004 Feb;92(2):202-7. doi: 10.1093/bja/aeh046.
Although obese patients are thought to be susceptible to postoperative pulmonary complications, there are only limited data on the relationship between obesity and lung volumes after surgery. We studied how surgery and obesity affect lung volumes measured by spirometry.
We prospectively studied 161 patients having either breast surgery (Group A, n=80) or lower abdominal laparotomy (Group B, n=81). Premedication and general anaesthesia were standardized. Spirometry was measured with the patient supine, in a 30 degrees head-up position. We measured vital capacity (VC), forced vital capacity, peak expiratory flow and forced expiratory volume in 1 s at preoperative assessment (baseline), after premedication (before induction of anaesthesia) and 10-20 min, 1 h and 3 h after extubation.
Baseline spirometric values were all within the normal range. All perioperative values decreased significantly with increasing body mass index (BMI). The greatest reduction of mean VC (expressed as percentage of baseline values) occurred after extubation, and was more marked after laparotomy than after breast surgery (23 (SD 14)% vs 20 (14)%). Considering patients according to BMI (<25, 25-30, >30), VC decreased after surgery by 12 (7)%, 24 (8)% and 40 (10)%, respectively. VC recovered more rapidly in Group A.
Postoperative reduction in spirometric volumes was related to BMI. Obesity had more effect on VC than the site of surgery.
尽管肥胖患者被认为易发生术后肺部并发症，但关于肥胖与术后肺容量之间关系的数据有限。我们研究了手术和肥胖如何影响通过肺活量测定法测得的肺容量。
我们前瞻性地研究了161例接受乳房手术（A组，n = 80）或下腹部剖腹手术（B组，n = 81）的患者。术前用药和全身麻醉均标准化。患者仰卧位、头部抬高30度时进行肺活量测定。我们在术前评估（基线）、术前用药后（麻醉诱导前）以及拔管后10 - 20分钟、1小时和3小时测量肺活量（VC）、用力肺活量、呼气峰值流速和第1秒用力呼气量。
基线肺活量测定值均在正常范围内。所有围手术期值均随体重指数（BMI）增加而显著降低。平均VC的最大降幅（以基线值的百分比表示）发生在拔管后，且剖腹手术后比乳房手术后更明显（23（标准差14）%对20（14）%）。根据BMI（<25、25 - 30、>30）对患者进行分析，术后VC分别下降了12（7）%、24（8）%和40（10）%。A组VC恢复更快。
术后肺活量测定值的降低与BMI有关。肥胖对VC的影响大于手术部位。
