Mahkovic-Hergouth K, Tos L, Stangl B
Univ. institut za anesteziologijo, Ljubljana.
Plucne Bolesti. 1990 Jul-Dec;42(3-4):138-43.
The study deals with the patients in the first postoperative hour following the operation in the upper abdomen or thorax. We considered the respiratory function of the patients in the first postoperative hour and how the respiratory function is influenced by the residua of general anesthesia at that time. Statistically significant decrease of postoperative SaO2 values was found and many patients were hypoxemic after the operation. We found decreased minute ventilation in the first postoperative hour in both groups of patients. Anyway the minute ventilation was more decreased in the abdominal group of patients who recovered from intravenous anesthesia. The conscience as well was more slowly returned to the patients in the abdominal group. In the first 30 minutes more abdominal patients suffered from the muscular weakness following intraoperative relaxation. But this first half an hour after the operation they had satisfactory level of analgesia left. To the contrary the postoperative pain was more severe in the thoracal group of patients. Postoperative gas exchange was more often and more seriously disturbed in the thoracal group of patients who in majority suffered from previous lung disease, which means they had greater ventilation/perfusion imbalance and greater right to left shunt. In the abdominal group only the patients who had relatively short intravenous anesthesia were found hypoxemic in the first postoperative hour. We think that in these patients the gas exchange abnormalities immediately after the operation are also caused by the hypoventilation which often follows general anesthesia.
该研究针对上腹部或胸部手术后首小时的患者展开。我们考量了患者术后首小时的呼吸功能，以及彼时全身麻醉残余物对呼吸功能的影响。研究发现术后动脉血氧饱和度（SaO2）值出现了具有统计学意义的下降，许多患者术后存在低氧血症。我们发现两组患者术后首小时的分钟通气量均有所下降。无论如何，静脉麻醉苏醒的腹部手术组患者的分钟通气量下降更为明显。腹部手术组患者意识恢复也更为缓慢。术后前30分钟，更多腹部手术患者出现术中肌肉松弛后的肌无力情况。但术后这半小时他们仍留有满意的镇痛效果。相反，胸部手术组患者术后疼痛更为剧烈。胸部手术组患者术后气体交换受干扰更为频繁且严重，该组大多数患者既往有肺部疾病，这意味着他们存在更大的通气/血流失衡以及更大的右向左分流。在腹部手术组，仅静脉麻醉时间相对较短的患者在术后首小时被发现存在低氧血症。我们认为，这些患者术后即刻出现的气体交换异常也是由全身麻醉后常伴随的通气不足所致。
