开胸术后复张性肺水肿的治疗

The treatment of postoperative reexpansion pulmonary edema

目的 :探讨机械通气在复张性肺水肿治疗中的作用。方法 :全组共 6例 ,年龄 ( 2 3± 5 )岁。单侧自发性气胸 ,肺萎陷超过 90 % ,持续 4周以上者 3例 ,3周以上者 2例 ;外伤性血气胸 ,一侧肺全部萎陷持续 4周以上者 1例。病人均行开胸手术 ,肺大疱缝扎术 5例 ,开胸止血术 1例。复张性肺水肿发生时间从萎陷肺复张后 15～ 3 0 m in不等 ,血气分析 Pa O2 ( 7.18± 1.73 )k Pa。结果 :术后均行机械通气辅助呼吸 ,通气时间 6～ 78h,平均 ( 4 8± 16) h,呼气末正压通气 ( PEEP) ( 0 .5 8± 0 .12 ) k Pa。机械通气期间保持病人每天适当出超 ,有效强心利尿。停用呼吸机前血气分析 Pa O2 ( 13 .0 3± 0 .93 ) k Pa,Fi O2 为 0 .4 0 ,病人均顺利脱机。结论 :在复张性肺水肿的治疗中维持病人充足的氧合和稳定的血流动力学状态至关重要 ,带 PEEP的机械通气非常有效。

Objective: To approach the ro le of mechanical ventilation in the treatment of postoperative reexpansion pulmon ary edema (RPE). Methods: There were 6 patients in t his series, their average age was 23±5. They suffered from spontaneous late ral pneumo thorax and their pulmonary collapse >90%. Three patients lasted more than 4 weeks , and 2 patients lasted more than 3 weeks. One patient suffered from trauma tic hemopneumothorax and one side whole lung collapse for more than 4 weeks.A thoracotomy was performed for all 6 patients.Among them,five had lung bullae s uture,and one underwent hemostasis. RPE occurred within 15 to 30 minutes after the collapsed lungs were reexpanded. Blood gas analysis showed that PaO 2 was 7.18±1.73 kPa. Results: All the patients were supp o rted by the mechanical ventilation for 6 to 78 hours (mean 48 ±16 hours). Posi tive end expiration pressure(PEEP) was 0.58±0.12 kPa. All the patients maintai ned adequate water export surplus everyday during mechanical ventilation. The ef fective cardiac diuretic was taken. When PaO 2 reached 13.03±0.93 kPa,FiO 2 was 0.40,and th e respirator was off line smoothly. Conclusion: It is very important to maintain sufficient oxygenation and stable hemodynamic st atus in the treatment of RPE. So PEEP is very effective.