胸腔鏡下手術と心肺機能

Thoracoscopic Surgery and Cardiopulmonary Functions

　胸腔鏡下手術に関連する心肺機能不全がしばしば認められる．（1）炭酸ガス吹き込みは胸腔内の視野を改善するが，循環抑制を引き起こす．（2）胸腔鏡下肺容量減少術は重症肺気腫の低侵襲治療であるが，麻酔覚醒後に高炭酸ガス血症（通常70mmHg以上）が起こる．（3）肺切除術後や食道離断術後に心房細動が高い頻度で出現する．これらの合併症の治療と予防について述べる．

Cardiac and/or pulmonary dysfunctions related to thoracoscopic surgery occur frequently. Carbon dioxide insufflation during thoracoscopy, although facilitates exposure of the intrathoracic structures, results in hemodynamic compromise. Thoracoscopic lung volume reduction surgery is a minimally invasive treatment for severe pulmonary emphysema, but hypercapnia, more than 70 mmHg, deverops after emergence from anesthe-sia. Atrial fibrillation is common after lung surgery and esophagectomy. The treatment and prophylaxis of these complications are discussed.