胸科麻醉.pdf

AnesthesiaAnesthesia forfor ThoracicThoracic
SurgerySurgery
Peter D. Slinger,
Javier H. Campos
Development of thoracic surgery
• infectious indications (., lung abscess,
bronchiectasis, empyema) ——at the
beginning of the past century ；
• the most common indications are related
to malignancies (pulmonary, esophageal,
and mediastinal).
• end-stage lung diseases ，such as lung
transplantation and lung volume reduction
KeyKey PointsPoints
• Patients undergoing pulmonary resection
should have a preoperative assessment of
their respiratory function in three areas:
lung mechanical function,
pulmonary parenchymal function,
and cardiopulmonary reserve (the “three-
legged stool” of respiratory assessment).
RespiratoryRespiratory FunctionFunction
• The major task of the lung is to oxygenate
the blood and eliminate carbon dioxide
from it.
• To establish gas exchange in the human
lung, there must be ventilation of the
alveoli, diffusion through the alveolar-
capillary membranes, and circulation or
perfusion of the pulmonary capillary bed.
Ventilation
• A normal tidal breath at rest in an adult
subject is approximately to L；
• The respiratory frequency is around 16
breaths/min, with a range of 12 to 22
breaths/min；
• This results in ventilation of approximately
7 to 8 L/min.
Dead Space and Alveolar Ventilation
• All that is inspired does not reach the alveoli.
• Approximately 100 to 150 mL will be confined in
the airways and does not participate in gas
exchange.
• This “dead space” is approximately 30% of tidal
volume; that is, the Vds/Vt ratio is .
• Thus, “alveolar ventilation” is around 5 L/min,
similar to cardiac output, which is also 5 L/min.
The overall alveolar ventilation-perfusion ratio
accordingly is 1.
Dead Space and Alveolar Ventilation
Increased Dead Space Ventilation
• Dea