胸及上腹部手术后肺不张与呼吸衰竭的治疗体会

目的　探讨胸及上腹部手术后肺不张与呼吸衰竭的治疗方法。方法　术后肺不张患者 2 8例 ,全部行纤维支气管镜检查 ,术后呼吸衰竭需机械通气 18例 ,包括成人呼吸窘迫综合征 (ARDS) 5例 ,对ARDS患者采取保护性通气策略。结果　 2 3例粘稠痰液阻塞一侧主支气管或叶支气管 ,5例气管腔内只有少许粘液。治疗后 2 7例肺完全复张 ,1例死亡。呼吸衰竭患者机械通气时间 2～ 4d ,17例治愈 ,1例死亡。结论　用纤维支气管镜诊治胸及上腹部术后肺不张是相对安全有效的方法 ,但应考虑到各种不利因素 ,做好抢救准备。对呼吸衰竭需机械通气的患者 ,应判明有否ARDS ,采用相应的通气模式及参数

Therapeutic experience with atelectasis and respiratory failure induced by chest and upper abdominal surgery

Objective To explore the treatment for atelectasis and respiratory failure induced by chest or upper abdominal surgery.Methods Fiberoptic bronchoscope was performed in 28 patients with atelectasis.The mechanical ventilation was instituted in 18 patients with respiratory failure, 5 of whom suffered from acute respiratory distress syndrome(ARDS).The protective ventilatory strategy was applied to the patients with ARDS.Results Unilateral bronchus or lobe bronchus was obstructed by thick sputum in 23 patients, and a little mucus was found in bronchus in the remaining five patients.Complete re expansion was achieved in 27 patients and 1 died.In 18 patients with respiratory failure, the duration of mechanical ventilation ranged from 2 4 days, of whom 17 survived and 1 died.Conclusion Therapeutic fiberoptic bronchoscope is relatively safe and effective to re expand atelectatic lung, but various adverse factors should be noticed and emergency measures must be instituted prior to the procedure.It is necessary to make certain whether the patients requiring mechanical ventilation suffer from ARDS so as to adopt appropriate ventilatory models and parameters.