Gas Exchange, Gas Change (Pulmonary Function Test)
Entering or leaving the lungs in a minute volume of ventilation air-Mune "minute ventilation" is called. 6-8 liters at rest.
Some diseases require less ventilation (hypoventilation), some diseases require more ventilation (hyperventilation) occurs.
Hypoventilation causes chronic obstructive lung disease, pneumonia, tuberculosis, widespread fibrosis, pleural effusion, pneumothorax, general anesthesia, taking drugs such as morphine and the luminal rest hipoventilasyona causes.
According to various stimulus associated with recurrent spontaneous ventilation during sleep and is composed of episotları. Sleep apnea can vary from one consisting of ventilation in some patients episotları (sleep apnea syndrome). Thus, these persons is a significant hypoxemia and hypercarbia (respiratory acidosis) may occur and may develop respiratory and cardiac insufficiency. Changes in arterial blood gases of sleep apnea increases sympathetic and parasympathetic tone. For example, increased vagal tone may cause bradycardia atropine eliminated the bradycardia.
The main reasons for developing sleep apnea the muscles of the respiratory motor function decline and growing up and obstruction of the respiratory tract.
Hyperventilation causes hyperventilation normally consists of a growing effort by the degree. Hypoxia, hyperthyroidism, fever, excitement (anxiety), hyperventilation syndrome, cerebral hemorrhage, trauma, and andrenalin, taking drugs such as progesterone and testosterone develop hyperventilation at rest.
Diffusion of a gas from a region of high pressure passed into a region less pressure. Pulmonary diffusing capacity (DA) 1 min 1 mm Hg, alveolar-capillary oxygen pressure difference {(Aa) 02} days of oxygen volume in alveolar capillaries (V02), dir. DA = V02 / (Aa) 02 formula is calculated.
V02 = 250 ml / min, (Aa) O2 = 10 mm Hg, the OR = 250/10 = 25 ml / mmHg / min. Diffusing capacity increases with increasing body surface.
Diffusion capacity of the major reasons for the reduction of alveolar hypo-ventilation, alveolar-capillary block, ventilation / perfusion imbalance, and pulmonary circulatory abnormalities.
Perfusion (pulmonary circulation), lungs proper ventilation perfusion is an important factor for gas diffusion. Ventilation / perfusion imbalance by reducing the diffusion of hypoxemia (02 reduction) and hypercapnia (increase in C02) causes. Thus, the normal abnormal ventilation-perfusion or normal ventilation-perfusion regions of abnormal gas exchange effects and reducing the gas di-fusion of hypoxemia and hypercapnia can cause more serious cases.
Especially with chronic bronchitis, emphysema, pulmonary diseases and diffuse fibrosis, pulmonary vessels in cases of pulmonary embolism, resection and multple shrinking diameters, tıkanarak and decreased the number of perfusion abnormalities and pulmonary hypertension develops. Heart diseases, anemia and perfusion abnormalities may occur tirotok-sikozlarda.
Arterial blood gases, arterial blood gas main function of the lung alveolar capillaries to provide oxygen to pass and the capillaries are disposed of more than C02 understanding of abnormal pulmonary function in an objective way to measure arterial blood of 02 and C02.
However, a significant dysfunction gelişmemişse 02 and C02 levels remain normal. The main reasons for the increase in C02 reduction of 02 and pulmonary and cardiovascular diseases. Anemia also may be due.
Lips, tongue and fingertips syanozu classical clinical symptom of hypoxemia. However, this type of evaluation can be misleading. Shows little, such as by reducing or masking syanozu anemia than hypoxemia, polycythemia, whereas hypoxemia stimulates syanozu shows that as people collapsed. 02 For these reasons, arterial blood pressure (P02) and C02 pressure (pC02) assessment provides a more objective measurement of hypoxemia and hypercarbic. The main clinical signs of hypoxemia syanoz, severe exertional dyspnea, congestive heart failure, polycythemia, and restlessness, cerebral disorders such as insomnia and personality changes. P02 have a healthy adult living in the sea level was 90-100 mm Hg. P02 decreases with increasing age. 75 mm at the bottom of the normal value can be considered as HgP02. P02 Respiratory failure is usually less than 60 mm Hg. 25-35% should be given to 02 patients with treatment-related hypoxemia düzelmemişse. This can be used for a long time yoğunlukda 02. 02 Treatment of high concentration such as 100% "oxygen poisoning" can cause.
Normally, arterial blood pC02 is 35-45 mm Hg. Chronic increase of C02 (or respiatuar hperkapni acidosis), the main symptom of respiratory failure.
Respiratory acidosis clinical signs of drowsiness, confusion, difficulty speaking, the distal tremor, muscle spikes, headaches, small pupil, warm moist hand, papillary edema, and coma. These symptoms are not specific. Arterial gases (P02, pC02, and bicarbonates) are evaluated by measuring the acidosis is respiratory or metabolic.
Preoperative evaluation, preoperative preparation
There are a lot of complications related to anesthesia in surgical intervention. Lung, heart and upper abdominal surgery within 24 hours of the first major abnormalities in lung volumes such as a decrease in vital capacity is 50% or more. This reduction will take a week or so recovered. Temporary reduction of pain and muscle function in lung vo-lümlerinin related corruption.
Hypoxemia is quite common in surgery. Hypoxemia immediately after surgery, usually consisting of a reduction in lung volumes after ilgilidir.Bu period lasts for weeks or sometimes regress. The two major defense of the lungs and coughing in the postoperative period purification mukosilyer reduced.
Operative complications is closely related to the preoperative and intraoperative factors.
Preoperative Factors
Chronic lung diseases, especially chronic obstructive pulmonary disease has a lot of important complications of the surgery. During this period, lung function tests measured the degree of abnormality increases with increasing severity of them on the surgical complication. Forced vital capacity 1 seconds (ZVK1) 0.8 liters of surgical intervention is less often applied. Smoking, obesity, age and nutrition bozukluklarınında has to do with surgical complications. Surgical intervention before the patient's lungs, heart and other organs of the fızyopatalojik abnormalities should be evaluated together.
Intraoperative factors
This issue features of anesthesia, surgery type, location and size of the main factors in the incision.
Overall Evaluation for Surgical Intervention
The patient's background and examination, chest radiography, pulmonary function and blood gases are examined. Chest radiograph should be drawn, regardless of the type of surgical intervention. ZVKl more than 2 liters, or 80% of the normal value is suitable for pneumonectomy. ZVKl 2 liters or less than 80% of the account in accordance with the formula is written below postpnömonektomi ZVKl.
Preoperative ZVK1X Postpnömonektomi ZVKl =% remaining lung perfusion
If you ZVKl postpnömonektomi more than 800 or 40% of normal, or more applicable to the pneumonectomy.
Preparation of the patient before surgery
1. Smoking cessation for at least 8 weeks prior to surgery.
2. Existing lung, heart and other diseases to be treated.
3.Özellikle in patients with chronic obstructive pulmonary surgery treatment should be provided for up to 48-72 hours. For example, bronchodilator drugs (if necessary, steroids) and antibiotics should be given.
4. The weakening of the patients fat.
5. She thoroughly explained the importance of postoperative cough and breathing exercises should be done and the required application.
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