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目的 评估食管癌、贲门癌不同术式术后早期动脉血气指标的变化及其与术后心肺并发症的关系。方法 92例食管、贲门癌患者入组研究 ,于术前 1周及术后 1～ 4日行动脉血气分析。结果 全组术后 1～ 4日动脉血氧分压(PaO2 )均较术前明显降低 (P <0 .0 5 )。术前低肺功能者血气指标变化更著 (P <0 .0 5 )。主动脉弓上 /颈部食管重建术者PaO2 的降低程度甚于主动脉弓下重建术者 (P <0 .0 5 )。保留膈肌功能的右侧剖胸术术后PaO2 的恢复较快。结论 食管癌、贲门癌各式剖胸手术均可导致术后低氧血症。其可能的原因为VA/Q失调 ;其程度与术前肺功能的状况及手术方式有关。术后低氧血症与心肺并发症的发生密切相关。
Objective To evaluate the changes of early arterial blood gas parameters in patients with esophageal or cardiac cancer after different operations and their relationship with postoperative cardiac and pulmonary complications. Methods A total of 92 patients with esophageal and cardiac cancer were enrolled in the study. Arterial blood gas analysis was performed 1 week before surgery and 1 to 4 days after surgery. Results The arterial partial pressure of oxygen (PaO2) was significantly lower on the 1st to 4th day after surgery in the whole group (P < 0.05). Preoperative low lung function showed more changes in blood gas index (P < 0.05). PaO2 decreased more in the aortic arch/neck esophagectomy than in the aortic arch reconstruction (P < 0.05). PaO2 recovery was faster after right thoracotomy with preserved diaphragmatic function. Conclusion All kinds of thoracic surgery for esophageal and cardiac cancer can lead to postoperative hypoxemia. The possible reason for this is the VA/Q imbalance; the degree of this is related to the condition of the preoperative lung function and the surgical method. Postoperative hypoxemia is closely related to the occurrence of cardiopulmonary complications.