老人外科における肺機能の検討
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概要
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Surgical procedures among the aged have recently increased and the management is complicated by the problem that the incidence of postoperative complications and mortality in elderly patients are more frequent than young adults. Pulmonary complications have ranked first among postoperative disturbances and as a cause of mortality. Preoperative respiratory function and changes of acid-base balance and serum electrolytes during postoperative course were evaluated in elderly patients over 65 years of age in order to assure a smooth and uncomplicated surgical procedure. Poor pulmonary function as following pattern has been observed in the aged. Inspiratory and expiratory reserve volume, vital capacity, maximum breathing capacity and one second forced expiratory volume decreased with advancing age, while residual volume/total lung capacity ratio increased. Breathing reserve ratio slightly decreased. In mechanics of breathing considerable difference between static and dynamic compliance was noted. In exercise tolerance test increasing ratio of pulse and pressure, oximeter rate, and exercise index were elevated with decreasing tendency of oxygen removal ratio and ventilation index. These changes associated with aging appear to be due to diminished cardiopulmonary reserve. In changes of arterial blood determination pre- and postoperatively, predominant decrease of pH and the most elevated carbon dioxide tension immediately after operation were confirmed. Oxygen tension was reduced to postoperative 24 hours and followed general trend of delay in recovery. There was a negative level in base excess preoperatively in 38 per cent of patients, a marked metabolic acidosis was observed immediately following operation and evidence of metabolic acidosis still one week after surgery. Among changes of serum electrolytes, Na, K and Cl did not show significance with the analysis we used. Correlation studies illustrate some of the dysfunction with increasing age preoperatively, tendency of delay in recovery from operative procedure and serious potentialities of postoperative morbity and mortality. Preoperatively, elderly patients whose laboratory findings suggest a pulmonary abnormality must have their condition fully evaluated and treated before undergoing an operation. Adequate preoperative pulmonary preparation, proper ventilation or intensive pulmonary care may be considered to influence the incidence of postoperative pulmonary complications.
- 千葉大学の論文
- 1967-03-28
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- 老人外科における肺機能の検討