La Fianza A, Coven G, Preda L, Alberici E, Di Maggio E M, Madonia L, Campani R
Istituto di Radiologia, Università di Pavia.
Radiol Med. 1997 Dec;94(6):618-21.
Rationalizing preoperative chest radiography remains a problem in our Country. Therefore, we tried to use preoperative chest films rationally in obstetrics and gynecology to assess their impact on anesthesia planning and patient management and their use in early postoperative complications.
We examined two groups of patients: group A consisted of 570 women (mean age: 31 years) scheduled to be submitted to cesarean section but with no preoperative chest radiography; group B consisted of 471 patients (homogeneous in age to group A patients) submitted to nononcologic gynecologic surgery and with a single-projection preoperative chest radiograph. Anesthesiologic assessment, preoperative biochemical tests and EKG were performed in all patients. All patients underwent abdominal surgery under general anesthesia. The first 24 postoperative hours were monitored for possible anesthesia-related complications. The anesthesiologist need of chest radiography based on clinical findings was investigated in group A patients, as well as the importance of chest film findings in possible anesthesia-related complications.
Group A and group B were homogeneous by mean patient age and anesthesia duration; clinical findings never suggested the need of chest radiography in group A patients. Three cardiorespiratory complications occurred (two respiratory arrests in group A and a gas embolism in group B), but the (un)availability of chest film findings made no difference in treatment.
The availability of the preoperative chest radiographs of a group of healthy women of 31 years mean age does not make any difference in anesthesia planning and type. In our series, the most severe cardiorespiratory complications were homogeneous in the two groups, which confirms their random character, and the (un)availability of preoperative chest film findings made no real difference, even though the lack of radiographic evidence made patient management more demanding for anesthesiologists.
在我国，使术前胸部X线检查合理化仍是一个问题。因此，我们试图在妇产科合理使用术前胸部X线片，以评估其对麻醉计划和患者管理的影响以及在术后早期并发症中的应用。
我们检查了两组患者：A组由570名计划行剖宫产但未进行术前胸部X线检查的女性组成（平均年龄：31岁）；B组由471名接受非肿瘤妇科手术且术前有单部位胸部X线片的患者组成（年龄与A组患者相同）。所有患者均进行了麻醉评估、术前生化检查和心电图检查。所有患者均在全身麻醉下接受腹部手术。术后头24小时监测可能的麻醉相关并发症。调查了A组患者基于临床发现对胸部X线检查的需求，以及胸部X线片检查结果在可能的麻醉相关并发症中的重要性。
A组和B组患者的平均年龄和麻醉持续时间相同；临床检查从未提示A组患者需要进行胸部X线检查。发生了3例心肺并发症（A组2例呼吸骤停，B组1例气体栓塞），但胸部X线片检查结果的有无对治疗没有影响。
一组平均年龄为31岁的健康女性术前胸部X线片的有无对麻醉计划和类型没有任何影响。在我们的系列研究中，两组中最严重的心肺并发症情况相同，这证实了它们的随机性，并且术前胸部X线片检查结果的有无并没有实际差异，尽管缺乏影像学证据使麻醉医生对患者的管理要求更高。
