老年患者开胸术后急性呼吸衰竭不同治疗方案疗效比较

Comparative study on different treatments of postoperative acute respiratory failure by thoracotomy in elderly patients

目的:比较老年患者在开胸术后发生急性呼吸衰竭后常规气管插管与气管切开两种治疗方案的优劣性。方法:选取开胸术后发生急性呼吸衰竭的老年患者41例,按常规气管插管与气管切开分为两组,其中气管插管组患者24例,气管切开组患者17例,两组患者均予Drager4呼吸机辅助机械通气,同时予原发疾病治疗、抗感染治疗和营养支持治疗等。观察两组患者氧分压(PaO2)变化、人机对抗和呼吸机相关性肺炎发生率及死亡率。结果:气管切开较气管插管更能有效地改善急性呼吸衰竭患者的氧分压,且人机对抗和呼吸机相关性肺炎发生率及死亡率低于气管插管组。结论:对于术前合并异常肺功能的老年患者术后发生呼吸衰竭时应积极行气管切开,行机械通气治疗,并积极治疗原发疾病,采用有效抗生素和营养支持。

Objective： To evaluate the performances of trachea cannula and tracheotomy in the process of treatment of postoperative acute respiratory failure by thoracotomy in elderly patients. Methods： Forty-one elderly patients of postoperative acute respiratory failure by thoracotomy from January 2012 to April 2013 were selected and were divided into two groups： trachea cannula group （24 cases） and tracheotomy group （17 cases）. Respiratory support for all these patients were with Drager4 breathing machine. Meanwhile, primary disease treatment, anti-infective therapy and nutrition support therapy were emphasized. The variation of PaO2, the rate of man-machine confrontation and ventilator-associated pneumonia and death rate were observed. Results： Tracheotomy could effectively improve the variation of PaO2, the rate of man-machine confrontation and ventilator-associated pneumonia and death rate of tracheotomy group was lower than that of the trachea cannula group. Conclusion： Early respiratory support with tracheotomy plays a positive role in the treatment of postoperative acute respiratory failure by thoracotomy in elderly patients.