Nomori H, Horio H, Fuyuno G, Kobayashi R, Yashima H
Department of Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Eur J Cardiothorac Surg. 1996;10(5):352-8. doi: 10.1016/s1010-7940(96)80094-7.
Changes in respiratory muscle strength after lung resection were examined concerning age and procedures of thoracotomy. Maximum inspiratory (MIP) and expiratory (MEP) mouth pressure were measured before operation and 1, 2, 4, and 12 weeks after operation in 81 patients undergoing lung resection. In 48 patients undergoing pneumonectomy, lobectomy, or segmentectomy, patients older than 70 showed a significantly lower MIP and MEP before operation and throughout the postoperative period compared to younger ones (P < 0.01). Furthermore, the older patients showed a significantly lower percentage of postoperative MIP and MEP 4 weeks after operation than the younger ones (P < 0.01). In 31 patients undergoing lung wedge resection, patients undergoing limited thoracotomy (LT) and video-assisted thoracic surgery (VATS) showed significantly higher percentages of postoperative MIP and MEP than those undergoing posterolateral thoracotomy (PLT) 1 and 2 weeks after operation (P < 0.01 or 0.05). But there was no significant difference in the values between LT and VATS. We concluded that (1) elderly patients suffered respiratory muscle weakness before and after operation and their postoperative recovery of respiratory muscle strength was slower than in younger patients, and (2) VATS and LT resulted in more rapid recovery of respiratory muscle strength than PLT, but the difference between VATS and LT was not significant.
针对年龄和开胸手术方式，研究了肺切除术后呼吸肌力量的变化。对81例行肺切除术的患者，在术前及术后1、2、4和12周测量了最大吸气压（MIP）和最大呼气压（MEP）。在48例行肺叶切除术、肺段切除术或全肺切除术的患者中，70岁以上患者术前及术后整个时期的MIP和MEP均显著低于年轻患者（P<0.01）。此外，术后4周时，老年患者MIP和MEP的术后下降百分比显著高于年轻患者（P<0.01）。在31例行肺楔形切除术的患者中，接受有限开胸手术（LT）和电视辅助胸腔镜手术（VATS）的患者在术后1周和2周时，MIP和MEP的术后升高百分比显著高于接受后外侧开胸手术（PLT）的患者（P<0.01或0.05）。但LT和VATS之间的值无显著差异。我们得出结论：（1）老年患者术前和术后均存在呼吸肌无力，且其呼吸肌力量的术后恢复比年轻患者慢；（2）VATS和LT导致呼吸肌力量恢复比PLT更快，但VATS和LT之间的差异不显著。
