胸腔镜下肺减容术围术期处理的特殊问题

目的：总结慢性阻塞性肺疾病（COPD）患者在电视胸腔镜（VATS）下行肺减容术的围术期处理的问题。方法：该组7例均为男性，年龄65－76岁，按“慢性阻塞性肺疾病诊治规范（草案）”的气急分级标准，其中属4级4例，属3级3例。FEVI均小于50％（三级）。全组均有胸部CT显示上肺及肺周边有小而均匀之肺靶区。选择估计对肺功能影响较大的一侧肺先行手术，切除肺容量为术侧的20％－30％。结果：7例中术后有哮喘性支气管炎发作致呼吸困难3例，其中需行气管切开2例（均未用呼吸），1例因咳嗽频繁剧烈致肺泡漏气，胸管引流48h内拔除胸腔引流管，。术后需继续吸氧6d5例，吸氧8d2例，全部临床症状明显改善，与术前相比FEV1上升30％－45％，气急指数上升1－2级，均步行出院。结论：术前调节水电解质平衡，进行适当的呼吸运动训练，以及术后合理的氧疗法，保持呼吸道通畅，提高呼吸功率等是至关重要的。在紧急情况下应果断行气管切开术。

THE PREOPERATIVE AND POSTOPERATIVE MANAGENMENT IN LUGN VOLUME REDUCTION SURGERY FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Objective:To evaluate the preoperative and postoperative management in lung volume reduction surgery for patients with chronic obstructive pulmonary disease.Methods:All 7 patients were male.Age ranged from 65～76 years.Preoperative dyspnea index was grade 4 in 4 and grade 3 in 3.FEV1 were all less than 50%.We performed unilateral Lung volume reduction surgery on the lung that was estimated to have poorer lung function.The resected lung volume was 20%～30% of the operated.Results:2 tracheotomy were performed.Postoperative oxygen supply lasted 6～8d.The symptoms such as palpitaion,dyspnea were improved significantly.FEV1 and dyspnea index were respectively increased by 30%～45% and 1～2 grade.All patients recovered.Conclusions:Preoperative adjustment of the balance of water and electrolyte,proper respiratory exercises,resasonable postoperative oxygn supply and maintenance of unobstructed respiratory tract,all these are important.Moreover,tracheotomy shoulde be perfored promptly in acute cases.