CAJ | 학술논문

目的对接受肺减容手术的重度阻塞性肺气肿患者,进行术后肺功能中期随访,以期评估其生活质量.方法重度慢性阻塞性肺病患者行胸腔镜单、双肺减容术44例中男33例,女11例；年龄46～70岁,平均(65.2±6.0)岁.分别于术前、术后12、24个月进行肺功能测定和生活质量评估,肺功能测定项目包括第1秒用力呼气容积(FEV1)、FEV1％预计值、残气容积(RV)、RV％预计值、动脉血氧分压(P02)、动脉血二氧化碳分压(PC02)；生活质量评估以问卷形式进行,主要包括是否合并静息下呼吸困难、是否睡眠良好、是否生活能基本自理、是否能适当参加家务劳动、是否能再次参加社会工作、是否有良好的精神状态、是否有业余爱好.P＜0.05为差异有统计学意义.结果 44例中除围术期因呼吸衰竭死亡1例,其余均治愈出院.随访39例,失访4例；39例随访患者中,1例于术后13个月因脑血管意外死亡,实访38例.术后12、24个月与术前相比,FEV1及FEV1％预计值增加,P＜0.05,差异有统计学意义；RV及RV％预计值降低,P＜O.05,差异有统计学意义；P02升高、PC02下降,P＜0.05,差异亦有统计学意义；而各项指标在术后24和12个月相比无明显变化.通过问卷形式进行生活质量评估也有明显改善.结论对重度阻塞性肺气肿患者行肺减容术,中期可改善患者肺功能和生活质量,其促进作用不会在短期内消失.
목적 대접수폐감용수술적중도조새성폐기종환자,진행술후폐공능중기수방,이기평고기생활질량.방법 중도만성조새성폐병환자행흉강경단、쌍폐감용술44례중남33례,녀11례；년령46～70세,평균(65.2±6.0)세.분별우술전、술후12、24개월진행폐공능측정화생활질량평고,폐공능측정항목포괄제1초용력호기용적(FEV1)、FEV1％예계치、잔기용적(RV)、RV％예계치、동맥혈양분압(P02)、동맥혈이양화탄분압(PC02)；생활질량평고이문권형식진행,주요포괄시부합병정식하호흡곤난、시부수면량호、시부생활능기본자리、시부능괄당삼가가무노동、시부능재차삼가사회공작、시부유량호적정신상태、시부유업여애호.P＜0.05위차이유통계학의의.결과 44례중제위술기인호흡쇠갈사망1례,기여균치유출원.수방39례,실방4례；39례수방환자중,1례우술후13개월인뇌혈관의외사망,실방38례.술후12、24개월여술전상비,FEV1급FEV1％예계치증가,P＜0.05,차이유통계학의의；RV급RV％예계치강저,P＜O.05,차이유통계학의의；P02승고、PC02하강,P＜0.05,차이역유통계학의의；이각항지표재술후24화12개월상비무명현변화.통과문권형식진행생활질량평고야유명현개선.결론 대중도조새성폐기종환자행폐감용술,중기가개선환자폐공능화생활질량,기촉진작용불회재단기내소실.
Objective To observe the mid-term changes of pulmonary function and quality of life in the patients with emphysema who have undergone lung volume reduction surgery.Methods 44 subjects with severe emphysema underwent single or double lung volume reduction surgery through thoracoscope.There were 33 male and 11 female in the population analyzed with an age range of 46 to 70 years old.The mean age of the patients was (65.2-± 6.0) years.The pulmonary function and quality of life evaluation were determined over 3 time periods:prior to surgery,12 months postsurgery,and 24 months postsurgery Pulmonary function measurement project including the forced expiratory volume in 1 second (FEV 1),FEV 1％ of predicted value,residual volume (RV),RV ％ of predicted value,partial pressure of oxygen(PO2),partial pressure of carbon dioxide (PCO2),life quality evaluation performed in the form of questionnaire,including whether under anhelation,satisfactory sleep,living by self-care,participating in household duties,taking part in social work,whether to have a good mental state and have a hobby.Results There was 1 death of 44 patients from respiratory failure.43 patients recovered smoothly.4 cases were lost to follow-up.In 39.patients with follow-up,1 patient succumbed to cerebrovascular at 13 months after surgery.The other 38 cases compared with the preoperative at 12 and 24 months postsurgery,postoperative forced expiratory volume in 1 second (FEV1) increased,P ＜ 0.05,residual gas volume (RV) decreased,P ＜ 0.05,partial pressure of oxygen (PO2) increased,P ＜ 0.05,partial pressure of carbon dioxide (PCO2) decreased,P ＜ 0.05,meanwhile,the quality of life has improved significantly.Conclusion Lung volume reduction surgery in patients with severe obstructive emphysema can improve pulmonary function and quality of life.And its effect would not disappeared in the short term.