Sabanathan S, Eng J, Mearns A J
Department of Thoracic Surgery, Bradford Royal Infirmary, UK.
J R Coll Surg Edinb. 1990 Jun;35(3):144-50.
Major alteration in respiratory mechanics occur in all patients following anaesthesia and thoracotomy because of a decrease in the functional residual capacity with minimal change in the closing volume leading to airway closure during tidal breathing and atelectasis. Diminished pulmonary reserve, because of non-pulmonary and pulmonary risk factors before operation, and/or restrictive ventilation and abnormal pattern of breathing due to postoperative pain sustain and aggravate these changes. These can proceed to postoperative pulmonary complications in some normal, and in many high risk, patients. Detection and correction of pre-existing pulmonary disease, smoking, sepsis and obesity is essential to reduce postoperative morbidity and mortality. Effective postoperative regional analgesia minimizes impairment of pulmonary function, aids in its recovery, and prevents postoperative pulmonary complications. The adjuvant use of chest physiotherapy and incentive spirometry should also help in decreasing the adverse affects of anaesthesia and surgery on the chest and thereby reduce the frequency and severity of postoperative complications.
由于功能残气量减少，而闭合气量变化极小，导致潮式呼吸时气道关闭和肺不张，所有患者在麻醉和开胸术后呼吸力学都会发生重大改变。术前因非肺部和肺部危险因素导致的肺储备减少，和/或术后疼痛引起的限制性通气及异常呼吸模式会维持并加重这些变化。在一些正常患者以及许多高危患者中，这些变化可能会发展为术后肺部并发症。检测并纠正术前存在的肺部疾病、吸烟、脓毒症和肥胖对于降低术后发病率和死亡率至关重要。有效的术后区域镇痛可将肺功能损害降至最低，有助于肺功能恢复，并预防术后肺部并发症。辅助使用胸部物理治疗和激励性肺量测定法也应有助于减少麻醉和手术对胸部的不良影响，从而降低术后并发症的发生率和严重程度。
