机械通气并发气胸的诊断及处理

Diagnosis and management of the pneumothoraxcomplicating mechanical ventilation

气胸是机械通气常见的并发症，在成人呼吸窘迫综合征（ＡＲＤＳ）及慢性阻塞性肺部疾病（ＣＯＰＤ）中发生率较高，分别是２９．４％和２７．８％，且多为张力性气胸。预防气胸发生的简便方法是在保证有效通气量的前提下，适当降低潮气量。机械通气过程中，患者出现血氧饱和度下降、气道压力增高、患侧呼吸音降低、心率加快及呼吸困难等临床症状均高度提示并发气胸，试穿患侧胸腔有大量气体即可诊断。安置该侧胸腔闭式引流是有效的治疗方法。

One of the common complications in mechanical ventilation is tension pneumothorax.In this paper 164cases receiving mechanical ventilation were reviewed,and pneumothorax was foundto have high incidences inARDS and COPD.The critical factor to prevent pneumothorax was to reduce the tidal volume,but the alveolarventilation must be ensured by increasing the respiratory rates.In patients receiving mechanical ventilation,pneumothorax should be suspected if some of the following clinical manifestations appeared abruptly,e.g.,decreased blood oxygen saturation,increased airway pressure,dininished breath sound of the involved lung,tachycardia and dyspnea.The diagnosis was made by detecting the air from the pleural space by direct neelepuncture,The effective treatment was closed thoracic drainage.