Jackson C V
Division of Pulmonary Medicine, US Air Force Medical Center, Lackland Air Force Base, Tex.
Arch Intern Med. 1988 Oct;148(10):2120-7.
Factors related to risk of perioperative pulmonary complications include site of incision, obstructive lung disease, prolonged anesthesia time, smoking history with productive cough, and obesity. Hypercapnia is a consistent indicator of high risk. There is no difference between spinal and general anesthesia with regard to risk of pulmonary complications. In patients being evaluated for lung resection, high-risk indicators include predicted postoperative forced expiratory volume in one second of less than 1000 mL, hypercapnia, severe dyspnea on exertion, or advanced age when it is associated with advanced cardiopulmonary disease. Newer methods of assessing cardiopulmonary reserve may prove useful in identifying which patients with one or more of these risk factors are suitable operative candidates. Prevention of postoperative complications in chronic obstructive pulmonary disease patients should begin in the preoperative period with discontinuation of smoking at least eight weeks before surgery and vigorous pulmonary toilet in the 48 to 72 hours before surgery. Prophylactic lung expansion maneuvers can be effective in decreasing the incidence of postoperative atelectasis in high-risk patients undergoing high-risk operations.
围手术期肺部并发症风险相关因素包括手术切口部位、阻塞性肺疾病、麻醉时间延长、有咳痰的吸烟史以及肥胖。高碳酸血症是高风险的一致指标。在肺部并发症风险方面，脊髓麻醉和全身麻醉之间没有差异。在接受肺切除术评估的患者中，高风险指标包括预计术后一秒用力呼气量小于1000毫升、高碳酸血症、运动时严重呼吸困难，或与晚期心肺疾病相关的高龄。评估心肺储备的新方法可能有助于确定哪些有这些风险因素中一个或多个的患者是合适的手术候选人。慢性阻塞性肺疾病患者术后并发症的预防应在术前开始，术前至少八周戒烟，并在手术前48至72小时进行积极的肺部清理。预防性肺扩张措施可有效降低接受高风险手术的高风险患者术后肺不张的发生率。
