胸腔镜下肺减容术围术期处理的特殊问题

THE PREOPERATIVE AND POSTOPERATIVE MANAGENMENT IN LUGN VOLUME REDUCTION SURGERY FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

目的 :总结慢性阻塞性肺疾病 (COPD)患者在电视胸腔镜 (VATS)下行肺减容术的围术期处理的问题。方法 :该组 7例均为男性 ,年龄 6 5～ 76岁 ,按“慢性阻塞性肺疾病诊治规范 (草案 )”的气急分级标准 ,其中属 4级 4例 ,属 3级 3例。FEV1均小于 5 0 % (三级 )。全组均有胸部CT显示上肺及肺周边有小而均匀之肺靶区。选择估计对肺功能影响较大的一侧肺先行手术 ,切除肺容量为术侧的 2 0 %～ 30 %。结果 :7例中术后有哮喘性支气管炎发作致呼吸困难 3例 ,其中需行气管切开 2例 (均未用呼吸机 ) ,1例因咳嗽频繁剧烈致肺泡漏气 ,胸管引流 48h内拔除胸腔引流管。术后需继续吸氧 6d 5例 ,吸氧 8d 2例。全部临床症状明显改善 ,与术前相比FEV1上升 30 %～ 45 % ,气急指数上升 1～ 2级 ,均步行出院。结论 :术前调节水电解质平衡 ,进行适当的呼吸运动训练 ,以及术后合理的氧疗法 ,保持呼吸道通畅 ,提高呼吸功率等是至关重要的。在紧急情况下应果断行气管切开术。

Objective:To evaluate the preoperative and postoperative management in lung volume reduction surgery for patients with chronic obstructive pulmonary disease.Methods:All 7 patients were male.Age ranged from 65～76 years.Preoperative dyspnea index was grade 4 in 4 and grade 3 in 3.FEV1 were all less than 50%.We performed unilateral Lung volume reduction surgery on the lung that was estimated to have poorer lung function.The resected lung volume was 20%～30% of the operated.Results:2 tracheotomy were performed.Postoperative oxygen supply lasted 6～8d.The symptoms such as palpitaion,dyspnea were improved significantly.FEV1 and dyspnea index were respectively increased by 30%～45% and 1～2 grade.All patients recovered.Conclusions:Preoperative adjustment of the balance of water and electrolyte,proper respiratory exercises,resasonable postoperative oxygn supply and maintenance of unobstructed respiratory tract,all these are important.Moreover,tracheotomy shoulde be perfored promptly in acute cases.