动态血气分析对评估胸外科手术患者耐受力的研究
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摘要
开胸手术是胸外科治疗许多疾病的重要手段。但是由于开胸时间长、创伤大、对机体影响较大;全身麻醉对病人生理状态的影响大,术后伤口疼痛可诱发咳痰不畅、肺不张、胸腔积液、心率失常、肺部感染等术后并发症。
大量的研究资料表明,肺功能检测是评估外科,特别是心胸外科和腹部手术耐受力及围手术期维护措施选择的重要方法。肺功能指标的差异程度可以预测手术病人对于手术的耐受程度及术后心肺并发症(PPC)发生的多寡。通过肺功能检测,可以明确患者对于全身麻醉的耐受能力,能否耐受手术,能耐受何种手术,围手术期内风险度的评估,以及预测手术后可能发生的并发症等。因此,肺功能已作为临床中非常常用的一种检测方法。
血气分析是应用现代气体分析技术,对血液中所含的气体成分或气体分压、H +浓度进行直接的定量测定,并由此推算出有关参数,如O2分压、CO2分压、PH值、HCO3-浓度、剩余碱(BE)等,借以估计血液运输气体与肺部气体交换能力。目前血气分析主要用于:①诊断呼吸衰竭,并明确其类型和程度。②酸碱失衡的诊断和分型。③指导呼吸衰竭的临床治疗,包括氧疗和机械通气指征,呼吸机参数的调节,计算补充酸或碱剂的量。④判断患者疾病的治疗效果。⑤判断病人术前肺部气体交换能力,评估手术耐受力。因此,血气分析在临床中得到广泛应用并逐渐作为手术病人术前的常规检测项目。
然而,临床上由于部分病人不能很好的配合肺功能检测系统,以及病人个体意志能力等主观方面的差异,肺功能检测在一些情况下并不能如实反映患者的心肺功能、O2与CO2的交换能力。目前血气分析也只是术前静态检测心肺功能的一项指标,难以明确检测患者心肺功能的代偿能力。我们试图通过一系列研究,寻找一种较肺功能检测及血气分析更加准确、更加客观的评估术前患者心肺功能、手术耐受以及术后恢复情况的新方法。
目的:
1进一步明确肺功能检查对患者心肺功能的检测价值。
2测量血气分析的各项指标在胸外科开胸手术病人中的变化。
3阐明动态血气分析对病人术前评估、手术耐受程度及预后风险的指导意义。
4比较三者对于开胸手术病人手术耐受及术后恢复的评估价值。
方法:使用肺功能测定系统,按常规方法测定受试对象的肺功能;并根据肺功能情况进行分组,分为肺功能良好组、轻-中度受损组、重度受损组(患者一般情况可,根据临床经验考虑可行手术治疗,至于肺功能测试显示重度受损,可能由于部分病人不能很好的配合肺功能检测系统,肺功能检测结果未能如实反映患者的心肺功能及O2与CO2的交换能力)。对受试对象预留桡动脉留置针,于安静状态下采集动脉血并立即送检、同时使用美国产床旁监护仪(Philips Sure Signs VM6)记录安静状态下受试者各项生命指标(P、R、Bp、SaO2)。嘱患者爬楼梯(根据患者情况爬楼3-5层),于运动后继续记录受试者各项生命指标(P、R、Bp、SaO2),并于0、2、4、6min采集动脉血并立即送检,使用丹麦雷度(ABL-77)型血气分析仪,测量血气、详细记录血气结果的数据(PH值、PaO2、PaCO2、SaO2等)。术后观察病人恢复情况:是否使用呼吸机及带机的时间长短、肺部感染、肺不张、ARDS等的出现、恢复情况及死亡率的统计。将每组肺功能、血气分析结果与患者术后出现并发症情况进行分析,得出动态血气分析对患者手术耐受、术后恢复情况的对应关系。
结果:
1肺功能正常组10例,其中1例安静状态下SaO2<90%,术后此1例出现并发症(≥3种);余患者运动过程中或/和运动后血气变化不明显,术后无并发症发生。轻-中度受损组10例,1例运动后血气变化较明显(下降程度≥4%),术后此1例出现并发症;其余患者运动后血气变化不明显,术后1例患者出现并发症。肺功能重度受损组10例,其中患者运动过程中或/和运动后5例血气变化较明显(下降程度≥4%或/和下降至90%以下),其中4例出现并发症;3例血气变化不明显,其中1例出现并发症;2例安静状态下SaO2<90%,全部出现并发症(三组比较P<0.05)。
2 30例患者安静状态SaO2≤90%术后并发症出现情况(3/3)100%,运动后SaO2≤90%或下降幅度≥4%术后并发症出现情况(5/6)83.33%,符合以上标准及并发症出现情况合计(8/9)88.89%;安静状态SaO2>90%或运动后SaO2>90%或下降幅度<4%术后并发症出现情况(2/21)9.52% (两组比较P<0.05)。
结论:
1肺功能检测作为一种传统的术前评估心肺功能的检查项目,对于临床指导治疗是有其使用价值的,但由于部分病人不能很好的配合肺功能检测系统,肺功能检测在一些情况下并不能真实反映患者的心肺功能情况,有必要采用一种更加准确的方法进一步评估这一部分病人的心肺功能。
2动态血气分析较肺功能检测能够更加准确的预测患者术前心肺功能、手术风险及术后恢复情况,其最有价值的指标为运动后即刻(0 min)动脉血气的SaO2(或可用PaO2)。
3安静状态下血氧饱和度(SaO2)<90%或运动后下降程度≥4%或下降至90%以下患者对开胸手术耐受力较差,易出现术后并发症。
Thoracotomy surgery presently is an important treatment means in many diseases in thoracic departments. Because of long time open-chest surgery, big trauma, the influence of general anesthesia for physical condition and postoperative wound pain, will induce postoperative complications, such as sputum block, atelectasis, pleural effusion, arrhythmia, pulmonary infection.
A lot of research data shows that pulmonary function testing is an important method to evaluate the indications and perioperative safeguard measures of surgery, especially the thoracic surgeons and abdominal surgery. Current research and experiment have proved, pulmonary function degree can predict the tolerance for surgery surgical patients and the amount of occurs of postoperative complications (PPC). Through the lung function testing, we can define the tolerance for patients with general anesthesia, if he can tolerance surgery, and what, perioperative period of risk assessment, and the degree of complications may occur after surgery. Therefore, pulmonary function has been become a very common clinical detection methods.
Blood gas analysis is applied to modern gas analysis technology, to determine blood contains of gas composition or gas pressure, the concentration of H+ quantitatively, and calculate the relevant parameters, such as PaO2, PaCO2, PH, concentration of HCO3-,residual alkali(BE), etc.to estimated the exchange capacity of blood gas transportation with pulmonary gas. Currently blood gas analysis is mainly used for:(1 )diagnosis of respiratory failure, and define the type and extent, (2)acid-base imbalances diagnosis and classification, (3)guide clinical treatment of respiratory failure, including oxygen therapy and mechanical ventilation indications, breathing machines parameters adjustment, the calculation of supplementary acid or alkali, (4)judge therapeutic effect, (5)judging ability of patients gas exchange with pulmonary before surgery, evaluate operation tolerance. Therefore, the blood gas analysis is widely used in clinical surgery patients, and gradually as a routine testing project in patients before surgery.
However, due to some patients cannot very good with pulmonary function testing system, the differences of individual patients and subjective ability of will, pulmonary function testing in some cases cannot truthfully reflect the cardiorespiratory function of patients, exchange capacity with CO2 and O2. Currently blood gas analysis is an indicator of heart and lung functiontestintg only in static ,it is difficult to clearly detect heart and lung function in patients with compensatory ability. Through a series of studies we are trying to find a more accurate and more objective assessment methods than lung function testing and blood gas analysis in patients with preoperative surgical tolerance and post-operative recovery.
Objective:
1 To further clarify the lung function testing value of the patients with cardiopulmonary function.
2 Measurement the change of index about blood gas analysis in the thoracic open-chest surgery patients.
3 Clarify the significance of the dynamic analysis of blood gas,in surgical patients preoperative assessment of risk, degree of tolerance and prognostic.
4 Compare three thoracotomy surgery patients for evaluation of tolerance and postoperative recovery value.
Methods: Use lung function measurement system, according to the conventional method for determining the subject lung function. And according to the lung function situation to groups: good pulmonary function group, light - moderate damaged group, severely damaged(Patients generally available, according to the clinical experience considered viable surgery, for pulmonary function testing showed severely damaged, probably because of some patients cannot very good with pulmonary function testing system, pulmonary function testing cannot truthfully reflect the cardiorespiratory function of patients, exchange capacity with CO2 and O2.Give the patients to lien radial injecetiong needle. In quiet condition collecting blood and immediately defecate, Use ECG monitoring instrument records quiet condition index (P, R, Bp, SaO2). Ask patients to stairs up (according to the patient situations 3-5 layers), after sports continue to record all life subjects.(P, R, Bp, SaO2), And from 0, 2, 4, 6min collecting blood and immediately censorship, Use Danish Ray degrees ABL-77 analyzer, measurement of analysis of blood gas, a detailed record of the data of the analysis of blood gas. (PH, PaO2, PaCO2, SaO2etc). Postoperative closely observe the patient’s recovere situation, whether the ventilator machine and the length of time, and pulmonary infection, atelectasis, ARDS etc, recovery and mortality statistics. Analysis each group of lung function, blood gas analysis results and the postoperative complications, draw corresponding relation of the dynamic analysis of the blood gas, and postoperative patients tolerated the recovery.
Results:
1 With normal lung function, including 10 people 1 quiet condition SaO2 <90%, and postoperative complications were only this 1 patients within movement process or/and after motion analysis of blood gas does not change significantly, and postoperative complications is no occur. With light-moderate damaged 1 case of 10 patients after motion with the change (≥4%) and this patients occured postoperative complications; After more than natural movement does not change significantly, and only this 1 patients occured postoperative complications. With severely damaged lung function of 10 cases, 5 cases of 10 patients after movement have significant change (SaO2drop extent≥4% or down to less than 90%), 4 patients occured postoperative complications. 2 cases in quiet condition SaO2<90%, all the two occured postoperative complications.3 patients does not change significantly, 1 patients occured postoperative complications (P<0.05).
2 Within 30 patients in quiet condition SaO2<90% of postoperative complications appears (3/3) 100%, SaO2<90% after motion or decline the extent>4% of postoperative complications appears (5/6)83.33%, With the above standards and complications situation aggregate (8/9) 88.89%, SaO2 > 90% in quiet condition or SaO2>90% after motion or declines<4% postoperative complications appears (2/21) 9.52% (the two groups P<0.05).
Conclusion:
1 Pulmonary function testing as a kind of traditional evalution the cardiorespiratory of preoperative patients, for clinical treatment has its use value, but some patients cannot very good with pulmonary function testing system, pulmonary function testing cannot truthfully reflect the cardiorespiratory function of patients. We need to adopt a more accurate method to further assess this part of the patients cardiopulmonary function.
2 The dynamic analysis of analysis of the Blood gas can more accurately predict preoperative patients cardiorespiratory function, surgical risk, postoperative recovery situation than pulmonary function testing, And the most value evaluation index of surgical tolerance for sport immediately after the activities SaO2 (0min) (or PaO2 available).
3 Quiet condition oxygen saturation (SaO2)<90% or drop extent experiment≥4% after experiment or dropped to below 90% of the patients with thoracic surgery less tolerance presses.
大量的研究资料表明,肺功能检测是评估外科,特别是心胸外科和腹部手术耐受力及围手术期维护措施选择的重要方法。肺功能指标的差异程度可以预测手术病人对于手术的耐受程度及术后心肺并发症(PPC)发生的多寡。通过肺功能检测,可以明确患者对于全身麻醉的耐受能力,能否耐受手术,能耐受何种手术,围手术期内风险度的评估,以及预测手术后可能发生的并发症等。因此,肺功能已作为临床中非常常用的一种检测方法。
血气分析是应用现代气体分析技术,对血液中所含的气体成分或气体分压、H +浓度进行直接的定量测定,并由此推算出有关参数,如O2分压、CO2分压、PH值、HCO3-浓度、剩余碱(BE)等,借以估计血液运输气体与肺部气体交换能力。目前血气分析主要用于:①诊断呼吸衰竭,并明确其类型和程度。②酸碱失衡的诊断和分型。③指导呼吸衰竭的临床治疗,包括氧疗和机械通气指征,呼吸机参数的调节,计算补充酸或碱剂的量。④判断患者疾病的治疗效果。⑤判断病人术前肺部气体交换能力,评估手术耐受力。因此,血气分析在临床中得到广泛应用并逐渐作为手术病人术前的常规检测项目。
然而,临床上由于部分病人不能很好的配合肺功能检测系统,以及病人个体意志能力等主观方面的差异,肺功能检测在一些情况下并不能如实反映患者的心肺功能、O2与CO2的交换能力。目前血气分析也只是术前静态检测心肺功能的一项指标,难以明确检测患者心肺功能的代偿能力。我们试图通过一系列研究,寻找一种较肺功能检测及血气分析更加准确、更加客观的评估术前患者心肺功能、手术耐受以及术后恢复情况的新方法。
目的:
1进一步明确肺功能检查对患者心肺功能的检测价值。
2测量血气分析的各项指标在胸外科开胸手术病人中的变化。
3阐明动态血气分析对病人术前评估、手术耐受程度及预后风险的指导意义。
4比较三者对于开胸手术病人手术耐受及术后恢复的评估价值。
方法:使用肺功能测定系统,按常规方法测定受试对象的肺功能;并根据肺功能情况进行分组,分为肺功能良好组、轻-中度受损组、重度受损组(患者一般情况可,根据临床经验考虑可行手术治疗,至于肺功能测试显示重度受损,可能由于部分病人不能很好的配合肺功能检测系统,肺功能检测结果未能如实反映患者的心肺功能及O2与CO2的交换能力)。对受试对象预留桡动脉留置针,于安静状态下采集动脉血并立即送检、同时使用美国产床旁监护仪(Philips Sure Signs VM6)记录安静状态下受试者各项生命指标(P、R、Bp、SaO2)。嘱患者爬楼梯(根据患者情况爬楼3-5层),于运动后继续记录受试者各项生命指标(P、R、Bp、SaO2),并于0、2、4、6min采集动脉血并立即送检,使用丹麦雷度(ABL-77)型血气分析仪,测量血气、详细记录血气结果的数据(PH值、PaO2、PaCO2、SaO2等)。术后观察病人恢复情况:是否使用呼吸机及带机的时间长短、肺部感染、肺不张、ARDS等的出现、恢复情况及死亡率的统计。将每组肺功能、血气分析结果与患者术后出现并发症情况进行分析,得出动态血气分析对患者手术耐受、术后恢复情况的对应关系。
结果:
1肺功能正常组10例,其中1例安静状态下SaO2<90%,术后此1例出现并发症(≥3种);余患者运动过程中或/和运动后血气变化不明显,术后无并发症发生。轻-中度受损组10例,1例运动后血气变化较明显(下降程度≥4%),术后此1例出现并发症;其余患者运动后血气变化不明显,术后1例患者出现并发症。肺功能重度受损组10例,其中患者运动过程中或/和运动后5例血气变化较明显(下降程度≥4%或/和下降至90%以下),其中4例出现并发症;3例血气变化不明显,其中1例出现并发症;2例安静状态下SaO2<90%,全部出现并发症(三组比较P<0.05)。
2 30例患者安静状态SaO2≤90%术后并发症出现情况(3/3)100%,运动后SaO2≤90%或下降幅度≥4%术后并发症出现情况(5/6)83.33%,符合以上标准及并发症出现情况合计(8/9)88.89%;安静状态SaO2>90%或运动后SaO2>90%或下降幅度<4%术后并发症出现情况(2/21)9.52% (两组比较P<0.05)。
结论:
1肺功能检测作为一种传统的术前评估心肺功能的检查项目,对于临床指导治疗是有其使用价值的,但由于部分病人不能很好的配合肺功能检测系统,肺功能检测在一些情况下并不能真实反映患者的心肺功能情况,有必要采用一种更加准确的方法进一步评估这一部分病人的心肺功能。
2动态血气分析较肺功能检测能够更加准确的预测患者术前心肺功能、手术风险及术后恢复情况,其最有价值的指标为运动后即刻(0 min)动脉血气的SaO2(或可用PaO2)。
3安静状态下血氧饱和度(SaO2)<90%或运动后下降程度≥4%或下降至90%以下患者对开胸手术耐受力较差,易出现术后并发症。
Thoracotomy surgery presently is an important treatment means in many diseases in thoracic departments. Because of long time open-chest surgery, big trauma, the influence of general anesthesia for physical condition and postoperative wound pain, will induce postoperative complications, such as sputum block, atelectasis, pleural effusion, arrhythmia, pulmonary infection.
A lot of research data shows that pulmonary function testing is an important method to evaluate the indications and perioperative safeguard measures of surgery, especially the thoracic surgeons and abdominal surgery. Current research and experiment have proved, pulmonary function degree can predict the tolerance for surgery surgical patients and the amount of occurs of postoperative complications (PPC). Through the lung function testing, we can define the tolerance for patients with general anesthesia, if he can tolerance surgery, and what, perioperative period of risk assessment, and the degree of complications may occur after surgery. Therefore, pulmonary function has been become a very common clinical detection methods.
Blood gas analysis is applied to modern gas analysis technology, to determine blood contains of gas composition or gas pressure, the concentration of H+ quantitatively, and calculate the relevant parameters, such as PaO2, PaCO2, PH, concentration of HCO3-,residual alkali(BE), etc.to estimated the exchange capacity of blood gas transportation with pulmonary gas. Currently blood gas analysis is mainly used for:(1 )diagnosis of respiratory failure, and define the type and extent, (2)acid-base imbalances diagnosis and classification, (3)guide clinical treatment of respiratory failure, including oxygen therapy and mechanical ventilation indications, breathing machines parameters adjustment, the calculation of supplementary acid or alkali, (4)judge therapeutic effect, (5)judging ability of patients gas exchange with pulmonary before surgery, evaluate operation tolerance. Therefore, the blood gas analysis is widely used in clinical surgery patients, and gradually as a routine testing project in patients before surgery.
However, due to some patients cannot very good with pulmonary function testing system, the differences of individual patients and subjective ability of will, pulmonary function testing in some cases cannot truthfully reflect the cardiorespiratory function of patients, exchange capacity with CO2 and O2. Currently blood gas analysis is an indicator of heart and lung functiontestintg only in static ,it is difficult to clearly detect heart and lung function in patients with compensatory ability. Through a series of studies we are trying to find a more accurate and more objective assessment methods than lung function testing and blood gas analysis in patients with preoperative surgical tolerance and post-operative recovery.
Objective:
1 To further clarify the lung function testing value of the patients with cardiopulmonary function.
2 Measurement the change of index about blood gas analysis in the thoracic open-chest surgery patients.
3 Clarify the significance of the dynamic analysis of blood gas,in surgical patients preoperative assessment of risk, degree of tolerance and prognostic.
4 Compare three thoracotomy surgery patients for evaluation of tolerance and postoperative recovery value.
Methods: Use lung function measurement system, according to the conventional method for determining the subject lung function. And according to the lung function situation to groups: good pulmonary function group, light - moderate damaged group, severely damaged(Patients generally available, according to the clinical experience considered viable surgery, for pulmonary function testing showed severely damaged, probably because of some patients cannot very good with pulmonary function testing system, pulmonary function testing cannot truthfully reflect the cardiorespiratory function of patients, exchange capacity with CO2 and O2.Give the patients to lien radial injecetiong needle. In quiet condition collecting blood and immediately defecate, Use ECG monitoring instrument records quiet condition index (P, R, Bp, SaO2). Ask patients to stairs up (according to the patient situations 3-5 layers), after sports continue to record all life subjects.(P, R, Bp, SaO2), And from 0, 2, 4, 6min collecting blood and immediately censorship, Use Danish Ray degrees ABL-77 analyzer, measurement of analysis of blood gas, a detailed record of the data of the analysis of blood gas. (PH, PaO2, PaCO2, SaO2etc). Postoperative closely observe the patient’s recovere situation, whether the ventilator machine and the length of time, and pulmonary infection, atelectasis, ARDS etc, recovery and mortality statistics. Analysis each group of lung function, blood gas analysis results and the postoperative complications, draw corresponding relation of the dynamic analysis of the blood gas, and postoperative patients tolerated the recovery.
Results:
1 With normal lung function, including 10 people 1 quiet condition SaO2 <90%, and postoperative complications were only this 1 patients within movement process or/and after motion analysis of blood gas does not change significantly, and postoperative complications is no occur. With light-moderate damaged 1 case of 10 patients after motion with the change (≥4%) and this patients occured postoperative complications; After more than natural movement does not change significantly, and only this 1 patients occured postoperative complications. With severely damaged lung function of 10 cases, 5 cases of 10 patients after movement have significant change (SaO2drop extent≥4% or down to less than 90%), 4 patients occured postoperative complications. 2 cases in quiet condition SaO2<90%, all the two occured postoperative complications.3 patients does not change significantly, 1 patients occured postoperative complications (P<0.05).
2 Within 30 patients in quiet condition SaO2<90% of postoperative complications appears (3/3) 100%, SaO2<90% after motion or decline the extent>4% of postoperative complications appears (5/6)83.33%, With the above standards and complications situation aggregate (8/9) 88.89%, SaO2 > 90% in quiet condition or SaO2>90% after motion or declines<4% postoperative complications appears (2/21) 9.52% (the two groups P<0.05).
Conclusion:
1 Pulmonary function testing as a kind of traditional evalution the cardiorespiratory of preoperative patients, for clinical treatment has its use value, but some patients cannot very good with pulmonary function testing system, pulmonary function testing cannot truthfully reflect the cardiorespiratory function of patients. We need to adopt a more accurate method to further assess this part of the patients cardiopulmonary function.
2 The dynamic analysis of analysis of the Blood gas can more accurately predict preoperative patients cardiorespiratory function, surgical risk, postoperative recovery situation than pulmonary function testing, And the most value evaluation index of surgical tolerance for sport immediately after the activities SaO2 (0min) (or PaO2 available).
3 Quiet condition oxygen saturation (SaO2)<90% or drop extent experiment≥4% after experiment or dropped to below 90% of the patients with thoracic surgery less tolerance presses.
引文
1陈德凤,郎红娟,杨洁凌等.开胸手术术前肺功能锻炼的护理指导[J].解放军护理杂志, 2006, 23(4):14-15
2尤黎明.采集动脉血与血气分析[J].人民卫生出版社, 2002: 109-110
3 Ninan M, Sommers KE, Landreneau RJ, et al. Standardized Exercis-e Oximetry Predicts Postpneumonectomy Outcome[J]. Ann Thorac Surg, 1997, 64: 328-332
4张凤群.肺功能测定对胸腹部手术风险的评估作用[J ].《中国保健》医学研究版,2007, 15(10) : 6-7
5 Pazzella AT, Adebonojo SA, Hooker SG, et al. Complications of g-eneral thoracic surgery. Curr Probl Surg, 2000, 37:733-858
6 Doyle RL. Assessing and modifying the risk of postoperative pulm-onary complications.Chest, 1999, 115:77S
7曹飞,尤庆生,柯宏刚等.肺癌手术前肺功能的综合评判及其临床意义[J ].交通医学, 2007, 21(5): 566-567
8 Bolliger CT, Perruchoud AP. Functional evaluation of the lung rese-tion candidate. Eur Respir J 1998, 11: 198-212
9 Pate P, Tenholder MF, Griffin JP, et al. Preoperative assessment ofthe high-risk patient for lung resection .Ann Thorac Surg, 1996, 61:1494- 1500
10穆魁津,林友华.肺功能测定原理与临床应用[J ].北京医科大学中国协和医科大学联合出版社, 1992: 51
11陈启福.心胸外科疾病诊疗指南[J ].北京科学出版社, 1992:2
1许京玉,朴红梅,郑兰.肺功能检测在胸腹部手术评估中的应用[J ].吉林医学, 2007, 26(13):1510
2曹飞,尤庆生,柯宏刚等.肺癌手术前肺功能的综合评判及其临床意义[J ].交通医学, 2007,21(5):566-567
3 Preston Pate, MD, Michael F. Tenholder, MD, John P. Griffin, MD, etal. Preoperative Assessment of the High-Risk Patient for Lung Resection [J]. Ann Thorac Surg, 1996,61:1494-1500
4 J W Bolton, D S Weiman, J L Haynes, etal. Stair climbing as an indicator of pulmonary function[J ].chest, 1987, 11(92):783-788
5张凤群.肺功能测定对胸腹部手术风险的评估作用[J ].《中国保健》医学研究版, 2007, 15(10):6-7
6 Ferguson MK.Preoperative assessment of pulmonary risk [J]. Chest, 1999, 115(5Supp1): 58S-63S
7 Eskandari MK, R_he RY,Steed DL,eta1.Oxygen-dependent chronic obstructive pulmonary disease does not prohibit aortic aneurysm repmr [J].Am J Surg , 1999,178(2):125 -128
8张水军,吴阳等.腹部外科患者并存肺功能异常的围手术期处理[J].临床外科杂志, 2008, l6(2): 87-88
9 Miller JI. Physilolgic evaluation of pulmonary function in the candidate for lung resection [J].J thorac cardiovasc surg,1993,105(2):347-352
10尤黎明.采集动脉血与血气分析[J].人民卫生出版社, 2002: 109-110
11赵丽杰,刘秀芳,刘文艳.动脉留置针采血对血气分析检测结果的影响[J ].护理学杂志, 2005 , 20 (18) :47-48
12 Woodrow, Philip MA, RGN, DipN, Grad Cert Ed Arterial blood gas analysis[J].Nursing Standard ,2004,18(21):45-52, 54-55
13洪燕,蔡映云,张志凤.血气分析的临床思维[J].中国呼吸与危重监护杂志, 2006, 5(5):326
14张力平,陈国才,汪无虎.食管癌病人围手术期血气分析及临床意义[J].重庆医科大学学报, 2001, 26(3):332-334
15朱正洪,沈晓咏,倪国兴等.老龄食管癌手术前后动脉血气分析及治疗要点[J].老年医学与保健, 2003, 9(3): 168-170
16 Zaugg M, Lucchinetti E, Zalunardo MP, et al. Substantial Changes in Arterial Blood Gases During Thoracoscopic Surgery Can Be Missed by Conventional Intermittent Laboratory Blood Gas Analyses[J]. Anesthesia & Analgesia, 1998, 87(3): 647-653
17冯贵宁.急性呼吸窘迫综合征82例动态血气分析及其临床意义[J].中国医学理论与实践, 2003, 2003(6): 746-747
18 Mathew Ninan, MD, K. Eric Sommers, MD, Rodney J. Landreneau, MD etal. Standardized Exercise Oximetry Predicts Postpneumonectomy Outcome[J].Ann Thorac Surg, 1997, 64: 328-332
2尤黎明.采集动脉血与血气分析[J].人民卫生出版社, 2002: 109-110
3 Ninan M, Sommers KE, Landreneau RJ, et al. Standardized Exercis-e Oximetry Predicts Postpneumonectomy Outcome[J]. Ann Thorac Surg, 1997, 64: 328-332
4张凤群.肺功能测定对胸腹部手术风险的评估作用[J ].《中国保健》医学研究版,2007, 15(10) : 6-7
5 Pazzella AT, Adebonojo SA, Hooker SG, et al. Complications of g-eneral thoracic surgery. Curr Probl Surg, 2000, 37:733-858
6 Doyle RL. Assessing and modifying the risk of postoperative pulm-onary complications.Chest, 1999, 115:77S
7曹飞,尤庆生,柯宏刚等.肺癌手术前肺功能的综合评判及其临床意义[J ].交通医学, 2007, 21(5): 566-567
8 Bolliger CT, Perruchoud AP. Functional evaluation of the lung rese-tion candidate. Eur Respir J 1998, 11: 198-212
9 Pate P, Tenholder MF, Griffin JP, et al. Preoperative assessment ofthe high-risk patient for lung resection .Ann Thorac Surg, 1996, 61:1494- 1500
10穆魁津,林友华.肺功能测定原理与临床应用[J ].北京医科大学中国协和医科大学联合出版社, 1992: 51
11陈启福.心胸外科疾病诊疗指南[J ].北京科学出版社, 1992:2
1许京玉,朴红梅,郑兰.肺功能检测在胸腹部手术评估中的应用[J ].吉林医学, 2007, 26(13):1510
2曹飞,尤庆生,柯宏刚等.肺癌手术前肺功能的综合评判及其临床意义[J ].交通医学, 2007,21(5):566-567
3 Preston Pate, MD, Michael F. Tenholder, MD, John P. Griffin, MD, etal. Preoperative Assessment of the High-Risk Patient for Lung Resection [J]. Ann Thorac Surg, 1996,61:1494-1500
4 J W Bolton, D S Weiman, J L Haynes, etal. Stair climbing as an indicator of pulmonary function[J ].chest, 1987, 11(92):783-788
5张凤群.肺功能测定对胸腹部手术风险的评估作用[J ].《中国保健》医学研究版, 2007, 15(10):6-7
6 Ferguson MK.Preoperative assessment of pulmonary risk [J]. Chest, 1999, 115(5Supp1): 58S-63S
7 Eskandari MK, R_he RY,Steed DL,eta1.Oxygen-dependent chronic obstructive pulmonary disease does not prohibit aortic aneurysm repmr [J].Am J Surg , 1999,178(2):125 -128
8张水军,吴阳等.腹部外科患者并存肺功能异常的围手术期处理[J].临床外科杂志, 2008, l6(2): 87-88
9 Miller JI. Physilolgic evaluation of pulmonary function in the candidate for lung resection [J].J thorac cardiovasc surg,1993,105(2):347-352
10尤黎明.采集动脉血与血气分析[J].人民卫生出版社, 2002: 109-110
11赵丽杰,刘秀芳,刘文艳.动脉留置针采血对血气分析检测结果的影响[J ].护理学杂志, 2005 , 20 (18) :47-48
12 Woodrow, Philip MA, RGN, DipN, Grad Cert Ed Arterial blood gas analysis[J].Nursing Standard ,2004,18(21):45-52, 54-55
13洪燕,蔡映云,张志凤.血气分析的临床思维[J].中国呼吸与危重监护杂志, 2006, 5(5):326
14张力平,陈国才,汪无虎.食管癌病人围手术期血气分析及临床意义[J].重庆医科大学学报, 2001, 26(3):332-334
15朱正洪,沈晓咏,倪国兴等.老龄食管癌手术前后动脉血气分析及治疗要点[J].老年医学与保健, 2003, 9(3): 168-170
16 Zaugg M, Lucchinetti E, Zalunardo MP, et al. Substantial Changes in Arterial Blood Gases During Thoracoscopic Surgery Can Be Missed by Conventional Intermittent Laboratory Blood Gas Analyses[J]. Anesthesia & Analgesia, 1998, 87(3): 647-653
17冯贵宁.急性呼吸窘迫综合征82例动态血气分析及其临床意义[J].中国医学理论与实践, 2003, 2003(6): 746-747
18 Mathew Ninan, MD, K. Eric Sommers, MD, Rodney J. Landreneau, MD etal. Standardized Exercise Oximetry Predicts Postpneumonectomy Outcome[J].Ann Thorac Surg, 1997, 64: 328-332