肺动脉内膜剥脱术术后重症监护和管理

Intensive care and management after pulmonary endarterectomy

肺动脉内膜剥脱术(PEA)是治疗慢性血栓栓塞性肺动脉高压(CTEPH)最有效的方法。术后短期内存在循环及呼吸系统病理生理改变,需要严密的血流动力学监测,适当的机械通气设置及药物使用,从而平稳度过麻醉状态、顺利脱离呼吸机及停用血管活性药物。在此过程中,可出现呼吸、循环、中枢神经系统以及出凝血等方面的并发症,需要根据患者术前、术中及术后早期相关指标评估其风险,及早预防和发现并发症,进行有效的药物及机械辅助处理,使患者顺利的度过围手术期。

Pulmonary endarterectomy(PEA)is the most effective treatment for pulmonary thromboembolic pulmonary hypertension(CTEPH).There are pathophysiological changes of the circulatory and respiratory system in the short term after PEA,which require strict hemodynamic monitoring,appropriate mechanical ventilation settings and medicine use,so as to smoothly pass the anesthesia state,weaning from the ventilator and stopping vasoactive drugs.During this process,respiratory,circulatory,central nervous system and coagulation complications may occur.It is necessary to evaluate the risk according to the relevant indicators before,during and early after the operation,prevent and find the complications as soon as possible,and carry out effective drug and mechanical assisted treatment,so that the patients can pass the perioperative period smoothly.