Maldini B, Majerić-Kogler V
Department of Anaesthesia and Intensive Care, Institute for Mother and Child Health, Zagreb.
Acta Med Croatica. 1995;49(1):15-20.
The authors studied changes in the ventilation-perfusion ratio and pulmonary shunt in the course of pulmonary surgery in relation to their presurgery values. The study was conducted at the Jordanovac University Department for Thoracal Surgery in Zagreb, examining 35 patients in whom, owing to pulmonary carcinoma, thoracotomy and pulmonary resection were performed. Relevant data were obtained concerning hypoxemia, its incidence, and its intensity in the patients examined. The results obtained have shown that in the presurgery period all the patients had an elevation of pulmonary shunt and an increased ratio of ventilation and blood flow, leading to mild hypoxemia. During the operation, the fall of the pulmonary shunt amounted to 8%; it was smaller after the ligature (bronchi, artery, and vein of the respective lung or its part) than at the end of the surgery (P < 0.001), whereas the ventilation-perfusion ratio fell more markedly after ligature (P < 0.001) than at the end of the operation. The authors conclude that, by knowing the ventilation-perfusion ratio and pulmonary shunt in the presurgical period, it is not possible to predict the changes of these parameters in the course of surgery. This is of special importance, because hypoxemia, occurring as a result of changes in the ventilation-perfusion ratio and pulmonary shunt, seriously endangers the patient's fate during surgery.
作者研究了肺手术过程中通气-灌注比和肺内分流相对于术前值的变化。该研究在萨格勒布的乔丹诺瓦茨大学胸外科进行，检查了35例因肺癌接受开胸手术和肺切除术的患者。获取了有关所检查患者低氧血症及其发生率和严重程度的相关数据。所得结果表明，术前所有患者均存在肺内分流增加以及通气与血流比值升高，导致轻度低氧血症。手术过程中，肺内分流下降了8%；结扎（相应肺叶或其部分的支气管、动脉和静脉）后下降幅度小于手术结束时（P<0.001），而通气-灌注比在结扎后下降更为明显（P<0.001），大于手术结束时。作者得出结论，通过了解术前的通气-灌注比和肺内分流，无法预测手术过程中这些参数的变化。这具有特别重要的意义，因为由于通气-灌注比和肺内分流变化而出现的低氧血症，在手术期间会严重危及患者的命运。
