肺切除術後 肺機能의 變化 = Changes in Pulmonary Function after Pulmonary Resections

국문 초록 (Abstract)

術後經過가 양호한 肺切除術 및 開胸術환자들중 術前後의 肺機能檢査 資料가 充分한 17례를 대상으로 切除된 폐의 容積과 肺機能의 變化와의 관계를 調査하였고 李 등^3)의 문헌에서 인용된 開心術患者 22例의 術前後 肺機能檢査値와 肺切除術환자 12례의 검사치를 比較하였으며 중요한 結果를 要約하면 다음과 같다.
·强制肺活量 全肺氣量 및 强制呼氣量 1.0秒値는 2-4개의 肺分節이 切除된 경우는 0∼1개의 分節이절제된 경우와 비슷한 정도로 術後에 감소하였고 5∼10개의 分節이 절제된 경우에서 보다 심하게 감소하였다.
·强制呼氣量 0.5秒値, FEF200∼1,200ml 및 最大自發的 換氣量은 切除된 肺分節의 數에 비례하여 術後에 감소하는 경향을 보였다.
·殘氣量 및 殘氣量의 全肺氣量에 대한 비율은 術後에 증가하였는데, 切除된 肺分節이 증가함에 따라서 前者는 약간씩 감소, 後者는 증가하였다.
·FEF25∼75%는 肺切除의 경우에서 肺切除가 없었던 경우보다 術後에 더 심하게 감소하였으나, 切除된 肺分節의 數에 따른 차이는 없었다.
·肺切除群과 開心術群에서 强制肺活量, 機能的殘氣量 및 全肺氣量의 術後감소는 차이가 없었고 强制呼氣量 0.5秒値, 1.0秒, FEF200∼1,200ml, FEF 25∼75% 및 最大自發的 換氣量은 肺切除群에서 術後에 보다 심하게 감소하였다.
·殘氣量 및 FEV0.5/FVC의 術後증가는 開心術群에서 더 심하였고 殘氣量의 全肺氣量에 대한 비율 및 FEV1.0/FVC는 兩群에서 비슷한 術後증가를 보였다.
·肺切除 및 開心術患者의 術後 肺機能의 障害는 拘束性과 閉鎖性이 共存하는 混合性 障害로 판단되었다.

다국어 초록 (Multilingual Abstract)

Pulmonary functions are known to be changed with lung diseases and lung lung resections.
The changes of lung function are mainly due to loss of functioning lung parenchyms, but partly from the immobilization of the thoracic cage which is traumatized by the procedure of thoracotomy.
Understanding of changes in pulmonary functions in pre- and post- operative stages will improve methodology of the care for thoracic surgery parients.
Seventeen patients who had unilateral pulmonary resections and simple thoracotomies for various intrathoratic lesions were selected for study.
Patients consisted of bronchiectasis, 10 cases, lung cancer, 2 cases, pulmonary tuberculosis, 1 case, empyema 1 cae, esophageal achalasis, 1 case, dissecting aneurysm, 1 case, and mediastinal teratoma, 1 case.
Pulmonary functions were measured with Collins basic spirometer module and residual module pre-operatively and on the seventh postoperative day.
Patients were classified into three groups according to number of the pulmonary segments resected, namely simple thoracotomy group (group 1), 2-4 segments group (group 2), and 5-10 segments group (group 3), and correlations between pulmonary function change and removed numbers of lung segments were analyzed.
Also, the nature and severity of postoperative pulmonary dysfunctions in patients underwent pulmonary resection were compared with those changes in parients underwent open heart surgery with extracorporeal circulation.
The data of the cardiac cases were obtained from our previous publication.^3)
Mean values of forced vital capacity, total lung capacity and FEV1.0 for the group 3 decreased postoperatively and the decrease was greater than that of group 1 and group 2.
Reduction of FEV0.5, FEF200-1,200ml and maximal volutary ventilation measured postoperative period revealed that the degree of reduction was closely related to the number of segments resected.
RV and RV/TLC increased postoperatively in all three groups.
Postoperative reduction of FEF25∼75% in group 2 and group 3 was much greater than that of the simple thoracotomy group.
There was no significant difference of the postoperative reduction in mean value of FVC, FRC, and TLC between the pulmonary and cardiac cases.
However, postoperative reduction of FEV0.5, FEV1.0, FEF200-1,200ml, FEF25-75%, and MVV were much greater in pulmonary cases.
RV/TLC and FEV1.0/FVC increased postoperatively to the similar extent in pulmonary and cardiac cases.
The increase in RV and FEV0.5/FVE was much greater in the cardiac cases postoperatively.
Postoperative pulmonary dysfunction in pulmonary and cardiac cases was characterized by mixed pattern of the restrictive and obstructive lung abnormalities.