肺减容术后肺漏气的处理

Prevention and treatment of air leaks in lung volume reduction surgery

目的:总结肺减容术的主要并发症肺漏气的预防和治疗措施。方法:回顾性分析26例肺减容术的漏气发生率、严重程度、漏气时间、肺膨胀程度、有无残腔和脓胸的发生,以及与漏气相关的肺功能和生活质量。结果:共26例病人,其中6例未用牛心包垫和生物蛋白胶,20例加用牛心包垫和生物蛋白胶。全组平均漏气发生率为79.2%,无牛心包组漏气发生率100%,加用牛心包组72.2%。经纤维支气管镜生物蛋白胶堵死漏气2例,获得成功。加负压吸引5例,用无创呼吸机16例,气管切开呼吸机支持1例,脓胸1例,无死亡病例。结论:术后肺漏气是肺减容术成败的关键,也是影响肺功能和导致其他并发症的主要原因,术中牛心包和生物蛋白胶的应用、术后及早拔除气管内插管、呼吸机的应用、负压吸引的应用、纤维支气管镜生物蛋白胶堵死及呼吸功能锻炼是预防肺漏气和缩短漏气时间的有效手段。

Objective To summarize the method of prevention and treatment for air leaks of lung,which is the major complica-tion in lung volume reduction surgery.Method Retrospective studies were performed for the incidence rate,serious level and the pe-riod of air leak,lung expanding,empyema ,remain cavity,lung function and QOL relative with air leak in26patients who re-ceived lung volume reduction surgery.Results Bovine pericardia and biological-protein-glue were used in18cases,the others didn't.The average incidence rate of air leak was79.2%.It was72.2%in18patients by using bovine pericardia,but it was100%in6pa-tients who were not used bovine pericardia.succeeded in blocking air leak in2patients with biological,protein,glue by fibro,broncho-scope.Negative pressure suction was added in5patients.Noninvasive respirator Supported16patients.Tracheotomy was performed in1cases and assisted ventilation by respirator.1patient suffered from empyema.There are no patient died.Conclu sion Prevention of air leak is the key point in lung volume reduction surgery.It is also the major reason of poor lung function and causing other com-plications.It is the effective method for air leaks and decrease air leakage period.That includes application of bovine pericardia and biological-protein glue,noninvasive respirator ,negative pressure suction,removing intubation early postoperatively,blockage with bi-ological-protein-glue by fibro bronchoscope and the training of respiratory function.