消化道外科手术胃液吸入性肺炎的危险性及其预防

The Risk and Prevention of Gastric Aspiration Pneumonia in Gastrointestinal Surgery

目的探讨消化道外科手术胃液吸入性肺炎的危险性及其预防措施。方法对2007年1月-2015年1月期间5例因消化道外科手术所致的胃液吸入性肺炎的患者进行临床总结,其中食管癌手术4例,梗阻性结肠癌手术1例。患者麻醉时或术后发生呕吐后即出现激烈的呛嗽、呼吸困难、紫绀,面色潮红,脉率在140-180次/分,SPO2及血压下降以及高热持续不退等急性呼吸窘迫综合征表现。纤支镜发现支气管肺段开口处有胆汁样物或从气管内吸出胆汁样液体而确诊。结果虽经积极的抢救,但全部患者均因心肺功能衰竭而死亡。结论胃液吸入性肺炎是外科的一种灾难,气管插管全麻前未留置胃管及食管癌术后胃管引流不畅是其主要的诱发原因。

Objective To investigate the risk of gastric aspiration pneumonia associated with gastrointestinal surgery and its preventive measures. Methods The clinical data of 5 cases suffered gastric aspiration pneumonia due to gastrointestinal surgery from January 2007 to January 2015 were summarized,including 4 cases of esophageal cancer surgery and 1 case of obstructive colon cancer surgery. The vomit occurred in anesthesia and post-operation,and then intense choking cough and symptoms of acute respiratory distress syndrome such as dyspnea,flushing,pulse rate of 140 to 180 beats / min,SPO2 decrease,hypotension and persistent high fever were appeared. Bile-like liquid was found in bronchopulmonary segment opening by bronchoscopy or in endotracheal suction and gastric aspiration pneumonia was diagnosed. Result All 5 patients were died of heart and lung failure after aggressive rescue measures. Conclusions Gastric aspiration pneumonia is a disaster in surgery. The endotracheal intubation without indwelling stomach tube and poor drainage after esophageal surgery is the main predisposing causes.