蔡茂恩　游丽蓉

[摘要] 目的 探討重症肺气肿患者行双侧肺减容术的麻醉处理方法。方法 方便选取2015年6月—2016年6月该院收治的42例重度肺气肿患者作为研究对象，均行双侧肺减容术，麻醉方式采用低浓度吸入麻醉+硬膜外阻滞麻醉，观察麻醉效果。 结果 该组患者在麻醉及手术过程中的血流动力学基本稳定，术后37例顺利拔管，5例保留导管。术后未发生麻醉相关并发症，全部治愈出院。患者术后6个月的FEV1、PaO2水平分别为（46.6±12.4）%、（88.4±5.3）mmHg，均较术前显著提高，RV、TLC、PaCO2水平分别为（146.6±5.8）%、（90.2±18.3）%、（49.4±4.8）mmHg，均较术前显著降低（t=6.870、10.492、12.948、11.994、12.219，P<0.05）。术后6个月的呼吸困难分级：Ⅰ级10例，Ⅱ级21例，Ⅲ级11例，与治疗前相比（Ⅱ级8例、Ⅲ级22例、Ⅳ级12例），差异有统计学意义（χ2=33.426，P<0.05）。结论 重症肺气肿患者行双侧肺减容术采用低浓度吸入麻醉+硬膜外阻滞麻醉具有较好的麻醉效果，且安全性好。

[关键词] 双侧肺减容术；麻醉；重症肺气肿

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）03（c）-0097-03

Anesthesia Treatment of Lung Volume Reduction Surgery in Patients with Severe Pulmonary Emphysema

CAI Mao-en， YOU Li-rong

Department of Anesthesia， Affiliated Hospital of Putian College， Putian， Fujian Province， 351100 China

[Abstract] Objective To summarize the anesthesia treatment of lung volume reduction surgery in patients with severe pulmonary emphysema. Methods 42 cases of patients with severe pulmonary emphysema admitted and treated in our hospital from June 2015 to June 2016 were convenient selected as the research objects and were treated with lung volume reduction surgery， and the anesthesia way was the low-concentration inhaled anesthesia and epidural block anesthesia， and the anesthesia effect was observed. Results The hemodynamics was basically steady in the anesthesia and operation courses， after surgery， the tube of 37 cases successfully extracted， and the catheter of 5 cases was reserved， and anesthesia related complications did not occur after surgery， and all discharged after healing， and the FEV1 and PaO2 levels in six months after surgery were respectively （46.6±12.4）%，（88.4±5.3）mmHg， which obviously increased compared with those before surgery， and the RV，TLC，PaCO2 levels were respectively （146.6±5.8）%，（90.2±18.3）%，（49.4±4.8）mmHg， which obviously decreased compared with those before surgery（t=6.870，10.492，12.948，11.994，12.219，P<0.05）， in terms of dyspnea classification in six months after surgery， there were 10 cases in level Ⅰ， 21 cases in level Ⅱ， 11 cases in level Ⅲ， and those indicators before treatment were 8 cases in level Ⅱ， 22 cases in level Ⅲ and 12 cases in level Ⅳ， and the differences were obvious（χ2=33.426，P<0.05）. Conclusion The effect of low-concentration inhaled anesthesia and epidural block anesthesia of patients with severe pulmonary emphysema in the lung volume reduction surgery is better， with good safety.

[Key words] Lung volume reduction surgery； Anesthesia； Severe pulmonary emphysema

重症肺气肿是一种十分严重的COPD（慢性阻塞性肺疾病），患者具有较高的死亡风险，严重危害着人类健康。对于重症肺气肿，普通的内科治疗疗效十分有限，肺移植手术是治疗本病的有效手段，但是由于供肺来源稀缺，且容易产生免疫排斥等问题，所以肺移植手术在临床上的应用较少[1-2]。肺减容手术为重症肺气肿治疗开辟了新的思路，该手术能够有效缓解肺气肿患者的呼吸困难症状，改善肺功能[3-4]。在肺减容手术中，选用合理的麻醉方式对于保障手术的顺利实施具有重大意义。该文方便选取了2015年6月—2016年6月收治42例行双侧肺减容手术的重度肺气肿患者，对其术中的麻醉处理情况进行了回顾性分析，现报道如下。

1 资料与方法

1.1 一般资料

研究对象为方便选取该院收治的42例重度肺气肿患者。入组患者均符合《慢性阻塞肺疾病诊疗规范》中的肺气肿诊断标准。……