有创机械通气并发气胸的临床诊疗进展

Progress in clinical diagnosis and treatment of pneumothorax complicated by invasive mechanical ventilation

作为有效的生命支持手段,有创机械通气(invasive mechanical ventilation,IMV)已使千万危重症患者获益,但在应用过程中,可能会出现危及生命的并发症——气胸,尤其是张力性气胸。患有急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、支气管哮喘、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、肺炎等肺部基础疾病,呼吸机的参数及模式的不合理设置和IMV时中心静脉置管、胸腔闭式引流、支气管镜等有创操作,均容易导致气胸的发生。临床医师需要密切关注IMV过程中患者的病情变化,及时发现气胸,并视患者不同病情采用胸腔闭式引流、支气管镜介入、胸腔镜、外科手术等综合治疗手段,以最大限度地降低患者的病死率。

Invasive mechanical ventilation(IMV),as an effective means of life support,has benefited millions of critically ill patients.Nevertheless,one shortcoming of the technique lies in life-threatening complications,such as pneumothorax,especially tension pneumothorax,that may occur during the application process.Pneumothorax can easily occur in the following:1)patients with acute respiratory distress syndrome(ARDS),bronchial asthma,chronic obstructive pulmonary disease(COPD),pneumonia and other underlying lung diseases;2)false setting of ventilator parameters and modes;3)invasive operations(e.g.,central venous catheterization,closed thoracic drainage,bronchoscopy)in the process of IMV.The physicians are supposed to pay close attention to the condition change of patients during IMV,and make a timely diagnosis of pneumothorax.Taking patients’different situations into account,physicians can apply comprehensive treatments,such as closed thoracic drainage,bronchoscopy intervention,thoracoscopy and thoracotomy.In this way,the mortality of patients could be reduced to the maximum extent.