肺容积减少术治疗重度肺气肿患者的围术期处理经验

Perioperative treatment of lung volume reduction surgery for severe pulmonary emphysema

目的 :总结肺容积减少术 (L VRS)治疗重度肺气肿患者的围术期处理经验。方法 :1996年 7月— 2 0 0 1年 3月应用 L VRS治疗重度肺气肿 40例 ,其中同期双侧 L VRS11例 (1例为慢性呼吸衰竭患者 ) ,单侧 L VRS2 9例 (3例为对侧肿瘤行肺叶切除或肺部分切除术者 ) ,切除每侧肺容积约 2 0 %～ 30 %。从围术期并发症发生的多因素分析 ,探讨了术前功能锻炼、手术指征及术后处理。结果 :围术期死亡 1例 ,术后并发症发生率5 2 .5 % ,呼吸机辅助呼吸 >7日者 6例 (其中气管切开 4例 ) ,持续漏气 >1周者 12例 ,频发室性期前收缩 1例 ,膈神经麻痹 1例 ,应激性溃疡 1例。结论 :正规的呼吸康复训练、严格掌握手术指征及方法和恰当的围术期处理对降低 L

Objective:To evaluate the perioperative treatment of lung volume reduction surgery (LVRS) for severe pulmonary emphysema.Methods:From July 1996 to March 2001,40 patients with severe pulmonary emphysema underwent LVRS.The LVRS was performed unilaterally in 29 patients via posterolateral thoracotomy (including pulmonary nodule resection of wedge or lobectomy during LVRS in 3 cases ) and bilateral LVRS in 11 cases through median sternotomy or bilateral anterolateral thoracotomy. 20%30% of the volume of each lung was resected.Relevant factors in the production of complications during perioperative period were analyzed,and perioperative physical exercise indications for operation and postoperative care were evaluated.Results:The operative mortality was 2 5%.The complication incidence during postoperative period was 52 5%.Morbidity included prolonged respiratory support (>7 days) in 6 patients,persistent air leakage in 12 cases ,refractory ventricular extrasystole in 1 case,phrenic nerve palsy in 1 case,stress ulcer with bleeding in 1 case .Conclusions:Perioperative comprehensive pulmonary rehabilitation program,strict adherence to indications for operation,appropriate postoperative treatment are important for the success of this prosedure.