Tulla H, Takala J, Alhava E, Hendolin H, Manninen H, Kari A
Department of Surgery, Kuopio University Hospital, Finland.
Intensive Care Med. 1995 Apr;21(4):319-25. doi: 10.1007/BF01705410.
To evaluate the effects of intra-abdominal surgical emergency on breathing pattern and gas exchange and compare it with the changes induced by elective abdominal surgery.
Prospective clinical study.
Abdominal surgical departments in a university hospital.
Patients operated for intra-abdominal emergency (n = 10, EAS), elective upper abdominal (n = 19, UAS).
Breathing pattern and gas exchange were measured with a respiratory inductive plethysmograph and a gas exchange monitor. EAS patients had pre-operatively a classical rapid shallow breathing pattern and increased ventilatory demand due to increased energy expenditure. The operation improved the breathing to normal pattern (frequency, 26 +/- 5/min and 17 +/- 3/min, p < 0.01; tidal volume, 439 +/- 128 ml and 541 +/- 165 ml, NS., before and after surgery, respectively). Sighing was absent before and after EAS and strictly reduced after elective surgery (p < 0.01 for UAS). The operation restricted the abdominal-diaphragmatic breathing movement which was reflected as increased contribution of the rib cage to VT (%RC: from 37% +/- 15 to 57% +/- 15 for UAS p < 0.001; from 47% +/- 16 to 61% +/- 14 for EAS NS.). After EAS and UAS hypoxemia was common (p < 0.001) with frequent radiological pathology. We conclude that intra-abdominal surgical emergencies increase the ventilatory demand and challenge the respiratory system to marked adaptive changes both pre- and post-operatively.
评估腹部外科急症手术对呼吸模式和气体交换的影响，并将其与择期腹部手术引起的变化进行比较。
前瞻性临床研究。
大学医院的腹部外科科室。
接受腹部急症手术的患者（n = 10，EAS组），择期上腹部手术的患者（n = 19，UAS组）。
使用呼吸感应体积描记器和气体交换监测仪测量呼吸模式和气体交换。EAS组患者术前具有典型的快速浅呼吸模式，由于能量消耗增加，通气需求增加。手术使呼吸改善为正常模式（频率，术前和术后分别为26±5次/分钟和17±3次/分钟，p<0.01；潮气量，分别为439±128毫升和541±165毫升，无显著性差异）。EAS组术前和术后均无叹气现象，择期手术后叹气现象明显减少（UAS组p<0.01）。手术限制了腹式膈肌呼吸运动，这表现为胸廓对潮气量的贡献增加（胸廓贡献率：UAS组从37%±15%增至57%±15%，p<0.001；EAS组从47%±16%增至61%±14%，无显著性差异）。EAS组和UAS组术后低氧血症常见（p<0.001），且常伴有影像学病理改变。我们得出结论，腹部外科急症手术会增加通气需求，并使呼吸系统在术前和术后都面临显著的适应性变化。
