| 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. |
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