肺癌术后呼吸衰竭的原因分析及防治  

Etiological analysis and intervention of postoperative respiratory failure in patients with lung cancer

作　　者：乌立晖[1] 徐志飞[1] 赵学维[1] 李建秋[1] 钟镭[1] 吴彬[1] 潘铁文[1] 李成志[1] 薛磊[1] 孙耀昌[1] 

机构地区：[1]第二军医大学长征医院胸心外科,上海200003

出　　处：《解放军医学杂志》2008年第9期1124-1126,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析肺癌术后呼吸衰竭的原因并探讨其预防及治疗方法。方法回顾性总结2000年1月-2006年12月659例肺癌患者术后呼吸衰竭的发生情况，对术前肺功能，既往病史，呼吸衰竭的发生原因、预防措施及治疗等进行分析，以期为临床提供参考。结果659例患者中42例术后发生呼吸衰竭，发生率6．4％，均发生于术后1～5d。呼吸道感染、支气管哮喘、手术创伤、切口疼痛刺激、术前心肺功能异常等是引起术后呼吸衰竭的主要原因。42例中37例经呼吸机机械通气及对症处理后呼吸衰竭得到控制，2例死于呼吸衰竭后多脏器功能衰竭，2例死于呼吸窘迫综合征，1例死于严重呼吸道感染，死亡率11．9％。发生呼吸衰竭的患者术前各项肺功能指标均明显低于无呼吸衰竭者（P〈0．01）。全肺切除尤其是有全肺切除术后呼吸衰竭发生率明显高于肺叶和肺楔形切除术（P〈0．01）。结论呼吸衰竭是肺癌术后常见的围手术期严重并发症之一，死亡率高，治疗困难，尽早诊断、及时给予机械通气是抢救成功的最有效手段，加强围手术期呼吸道管理、避免手术并发症是预防的关键措施。探讨肺癌术后呼吸衰竭的原因及其特点，采取有效的防治措施在临床上具有重要意义。Objective To explore the causes, prevention and treatment of postoperative respiratory failure in patients with lung cancer. Methods The clinical data of 659 patients, admitted in Changzheng Hospital from Jan. 2000 to Dec. 2006, with lung cancer and suffered from postoperative respiratory failure were analyzed retrospectively. Preoperative lung function, past medical history, the etiology and preventive procedures, and the treatment methods for postoperative respiratory failure were also reviewed. Results Postoperative re spiratory failure was occurred in 42 of 659 cases, the incidence was 6.4%, and all the 42 cases occurred in 1 to 5 days after operation. The major etiopathogenisis of postoperative respiratory failure included respiratory infection, bronchial asthma, operative wound, postoperative incision pain, preoperative cardiopulmonary dysfunction, etc. The respiratory failure was controlled in 37 of the 42 cases by mechanical ventilation and symptomatic treatment. Two eases died of multiple organ failure, another 2 eases died of respiratory distress syndrome and 1 case died of severe respiratory tract infection, the mortality was 11.9%. The preoperative lung function indexes of patients with postoperative respiratory failure were significantly lower than that of those patients without postoperative respiratory failure （P〈0. 01）. The incidenee of postoperative respiratory failure in patients undergone pneumonectomy, especially right pneumonectomy was significantly higher than that of those patients undergone lobectomy or wedge resection of lung. Conclusions Respiratory failure is one of the most critical perioperative complications with high mortality in patients with lung cancer, ham to treat, and the early correct diagnosis and timely mechanical ventilation are the most effective emergency managements. To strengthen respiratory tract management during perioperative period and avoid operative complications are the key measures to prevent the patients with lung cancer from postoperative respiratory fa

关 键 词：肺肿瘤 胸外科手术 呼吸功能不全 呼吸 人工 

分 类 号：R734.2[医药卫生—肿瘤]