Bernstein Wendy K, Deshpande Seema
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Semin Cardiothorac Vasc Anesth. 2008 Jun;12(2):109-21. doi: 10.1177/1089253208319868.
The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung ventilation leads to a significant derangement of gas exchange, and hypoxemia can develop due to increased intrapulmonary shunting. Recent advances in anesthetic management, monitoring devices, improved lung isolation techniques, and improved critical care management have increased the number of patients who were previously considered inoperable. In addition, there is a growing tendency to offer surgery to patients with significant lung function impairment; hence a higher incidence of intraoperative gas-exchange abnormalities can be expected. The anesthesiologist must also consider the risks of denying or postponing a potentially curative operation in patients with lung cancer. Detailed consideration of the information provided by preoperative testing is essential to successful outcomes following thoracic surgery.
胸外科手术术前评估的目的是评估并采取措施以减少围手术期并发症，并让高危患者为手术做好准备。主要的呼吸系统并发症，如肺不张、肺炎和呼吸衰竭，发生在15%至20%的患者中，占3%至4%死亡率的大部分。肺部并发症的发生与较高的术后死亡率相关。旨在预防术后困难的策略有可能降低发病率和死亡率、缩短住院时间并改善资源利用。单肺通气会导致气体交换严重紊乱，由于肺内分流增加可出现低氧血症。麻醉管理、监测设备、改进的肺隔离技术以及加强的重症监护管理方面的最新进展，使得以前被认为无法手术的患者数量增加。此外，为肺功能严重受损的患者提供手术的趋势日益增加；因此，可以预期术中气体交换异常的发生率会更高。麻醉医生还必须考虑拒绝或推迟对肺癌患者进行可能治愈性手术的风险。详细考虑术前检查提供的信息对于胸外科手术后的成功结果至关重要。
