肺癌术后呼吸衰竭的预防和治疗

Prevention and treatment of post-operative respiratory failure in lung cancer patients

目的探讨肺癌术后呼吸衰竭的原因、预防及治疗.方法对我院1997年1月至2004年10月肺癌术后发生呼吸衰竭的22 例患者进行回顾性分析.结果术后呼吸衰竭发生率为5.4%.采用同步间歇指令通气(SIMV)+呼吸末正压通气(PEEP)模式进行机械通气治疗,16例作了气管切开.机械通气时间为10～240h(38.0±22.9)h.死亡3例,病死率为13.6%.结论呼吸道感染、支气管哮喘、手术创伤、伤口疼痛刺激、术前心肺功能异常等是引起术后呼吸衰竭的主要原因.尽早诊断、及时给予机械通气是抢救成功的最有效手段,加强围手术期呼吸道管理、避免手术并发症是预防术后呼吸衰竭的关键.

Objective To explore the reasons, prevention and treatment measures of post-operative respiratory failure in lung cancer patients.Methods 22 cases of post-operative respiratory failure in lung cancer patients were received mechanical ventilation in our hospital from January 1997 to October 2004 were analyzed retrospectively.Results The incidence of post-operative respiratory failure was 5.4%.The mechanical ventilation using of intermittent mandatory ventilation (SIMV) and positive end-expiratory pressure (PEEP), and 16 cases out of 22 received tracheotomy. The time of mechanical ventilation was 10～240 hours, median duration was (38.0±22.9)hours. The death was 3 patients with mortality of 13.6%.Conclusions Respiratory tract infection, asthma, operative wound, incision pain, abnormal pre-operative cardio-pulmonary function, etc, are the major reasons which caused post-operative respiratory failure. Correct early diagnosis, early mechanical ventilation are the most efficient ways to save life. Strengthening management on respiratory tact in peri-operative period and avoiding post-operative complications are the keys of preventing post-operative respiratory failure.