肺癌手術後肺合併症, その分類と対策

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  • Classification of postoperative pulmonary complications and its management in patients with lung cancer
  • キョクショ カンキ ケツリュウ ブンプ カラ ミタ ハイガン ノ シンテン ト

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The postoperative courses in 157 patients with lung cancer were classified into 4 groups : no postoperative problems (Group I, 116 patients), retention of sputum and/or atelectasis requiring bronchofiberscopy more than 2 times (Group II, 17 patients), tracheostomy and mechanical ventilation for more than 2 days (Group III, 14 patients) and postoperative death (Group IV, 10 patients). Pulmonary function study such as FEV1%, MVV/BSA, RL/TLC, ΔN2% and so on revealed that over the one-third of the patients suffered from chronic obstructive lung disease (COLD) of any degree and the frequency of COLD was significantly high in Group II_IV, compared with Group I.<BR>Predicted postoperative Index (predicted postoperative FEV1/normal VC) was 56.1+ 15.0% in Group I, 47.1+8.0% in Group II, 31.0+8.4% in Group III and 38.1+16.0% in Group IV, indicating a statistically significant difference between each group except for between Group III and IV.<BR>The postoperative epidural buprenorphine was effective in 90.1% of the patients. Parameters of expiratory function expressed as FVC, FEV1, PEFR, maximum expiratory pressure, cough pressure became significantly better after buprenorphine injection.<BR>The postoperative aminophylline injection (6 mg/kg 30 min) was effective to increase maximum transdiaphragmatic pressure significantly.<BR>We conclude that COLD was an important factor of postoperative risk, and that patients with predicted postoperative Index less than 30% was high risk for postoperative complication. Postoperative epidural anesthesia and aminophylline were useful for postoperative management.

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