摘要慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是临床上常遇的棘手问题,正确的术前评估和围术期处理是患者平稳度过围术期的关键.肺功能检测已成为术前评估的必需检查内容,评估指标中最常用的是第1秒用力呼气容积(forced expiratory volume in one second,FEV1)占预计值的百分比和第1秒用力呼气容积/用力肺活量(forced vital capacity,FVC)的比值.而最大氧耗量(maximal oxygen demand,VO2max)能更科学地反映患者复杂的临床状况,被认为是最有价值的术前评估指标.COPD患者术前准备的目标是去除加重肺功能损害的因素,积极纠正可逆的病理改变,包括抗炎、解痉、平喘等治疗措施.全身麻醉联合硬膜外阻滞的麻醉方式,以及术中保护性输液和肺通气策略有利于维护患者围术期的平稳和减少术后肺水肿的发生.

abstractsChronic obstructive pulmonary disease (COPD), a common tough clinical problem, needs appropriate preoperative assessment and perioperative treatment to keep patient safe during perioperative period.Lung function testing has become to be an essential preoperative test,in which the most commonly used parameters are forced expiratory volume in one second (FEV1) to expected value and forced expiratory volume in one second/forced vital capacity (FEV1/FVC).Meanwhile,maximal oxygen demand (VO2max)can be used to assess the complex clinical condition of patients more scientifically,and is considered to be the most valuable evaluation index.The purpose of preparation before surgery in patient with COPD is to remove factors that aggravate lung damage and to improve reversible pathological changes,including anti-inflammatory,spasmolysis and reliving asthma.General anesthesia combined with epidural block,as well as protective transfusion and ventilation strategy during the operation,is effective in maintaining perioperative stable and reducing postoperative accident of pneumonedema on patient.