食管癌术后呼吸功能不全病人的处理  

MANAGEMENT OF PATIENTS WITH POSTOPERATIVE RESPIRATORY DYSFUNCTION AFTER ESOPHAGEAL CARCINOMA OPERATION

作　　者：曹枫[1] 邹红[1] 何茹[1] 陈荣琳[1] 

机构地区：[1]深圳市第九人民医院(深圳市龙岗中心医院)综合ICU,深圳518116

出　　处：《现代预防医学》2008年第15期2997-2999,共3页Modern Preventive Medicine

摘　　要：[目的]分析食管癌术所致呼吸功能不全患者,呼吸机辅助通气时呼吸功能变化。[方法]将术后呼吸不全11例患者实施SIMV+PSV通气,其中5例同时给予肺通气保护策略(PVS),即潮气量(VT)=6ml/kg+呼末正压(PEEP)10cmH2O;6例按常规通气(VT=10ml/kg)进行。在通气第4h,第8h收集相关数据。[结果]PVS通气病人进气峰压明显低于常规通气病人(P﹤0.01),平均气道压高于常规通气病人(P﹤0.05),2例肺气压伤病人经PVS通气后病情得以控制。病人氧合均改善,10例72h内顺利撤机,1例因肺部感染而延长通气时间。[结论]辅助通气加PVS用于食管癌术后伴肺挫伤、呼吸功能不全病人,可防止肺过度膨胀,减低通气剪切力,有利于让病人尽快适应并代偿术后生理改变。[Objective] To analyze the respiratory mechanisms of the patients with postoperative respiratory dysfunction for esophageal carcinoma operation during assisted mechanical ventilation.Methods We studied 11patients with postoperative respiratory dysfunction for carcinoma of esophagus during synchronized intermittent mandatory ventilation and pressure support ventilation.5 cases of them used a protective ventilatory strategy（PVS）：tidal volume VT = 6ml/Kg,positive end expiratory pressure PEEP =10cmH2O;other 6 cases used normal ventilation：VT = 10 ml /kg.The respiratory data were recorded after 4h and 8h of ventilation.Results The inspiratory peak pressure of the patients in the PVS were obviously less than that of the patients in the normal ventilation（P﹤0.01）.The mean airway pressure was higher in the PVS patients than that in the normal ventilation（P﹤0.05）.The two cases with pneumothorax happened during normal ventilation didn’t deteriorated when used PVS model.The oxygenation was improved to some extent in all patients during assisted ventilation.9 cases weaned in 72 hours successfully.Only one delayed because of respiratory infection.Conclusion The method of protective ventilatory strategy basing on assisted ventilation is useful to the postoperative respiratory dysfunctional patients with pulmonary contusion for esophageal carcinoma.Because it can prevent hyperdistention of pulmonary and reduce lung injury by sheer stress force,also it is beneficial for patients to suit and compensate the postoperative physical changes,and wean early.

关 键 词：食管癌 外科手术后 呼吸功能不全 辅助通气 

分 类 号：R735.1[医药卫生—肿瘤]