机械通气治疗老年病人术后呼吸衰竭的临床研究  

Clinical study of mechanical ventilation in the treatment of postoperative respiratory failure in elderly patients after surgery

作　　者：胡新华[1] 陆品相[1] 葛春林[1] 张媛园[1] 王玲[1] 

机构地区：[1]上海市徐汇区中心医院,上海200031

出　　处：《中国现代医学杂志》2009年第11期1746-1748,1755,共4页China Journal of Modern Medicine

摘　　要：目的研究老年病人术后发生呼吸衰竭的诱因及影响机械通气疗效的因素。方法回顾性分析2003年8月～2008年7月外科重症监护病房67例术后呼吸衰竭老年病人的基础疾病、诱因及机械通气治疗效果。呼吸衰竭定义为术后机械通气48h以上或全身麻醉拔管6h后再插管行机械通气。结果诱因包括肺部感染、肺不张(39例),术后严重感染或重症胰腺炎导致的急性呼吸窘迫综合征(ARDS)/多脏器功能不全(MODS)(28例)。其中合并慢性阻塞性肺病(COPD)23例,重度营养不良26例,ASAⅢ～Ⅳ级39例。呼吸衰竭发生在术后(2.94±2.55)d,机械通气时间(16.12±14.09)d。死亡26例(38.8%),撤机成功41例(61.2%)。结论老年病人发生术后呼吸衰竭时,机械通气的应用应贯穿于救治过程;在维持适当通气的条件下,及时处理原发疾病、有效控制感染、积极进行营养支持是影响机械通气成败的关键因素。[Objective] To study the predisposing factors in the development of postoperative respiratory failure （PRF） in elderly patients undergoing surgery and the factors affecting the therapeutic effect of mechanical ventilation. [Methods] A retrospective study was undertaken for PRF in 67 elderly patients in surgical ICU from Aug, 2003 to Jul, 2008. The underline diseases, introducing causes and efficacy of mechanical ventilation were retrospectively analysed. PRF Was defined as of mechanical ventilation after operation lasting for more than 48 hours or reintubation and mechanical ventilation within 6 hours after extubation. [Results] Postoperative lung infection, atelectasis were the causes of PRF in 39 eases and ARDS/MODS caused by severe surgical site infections or severe panereatitis in 28 cases. Of the 67 cases, complicated with COPD in 23 cases, severe malnutrition in 26 cases, ASA grade Ⅲ-Ⅳ in 39 cases. Respiratory failure occurred at （2.94 ±2.55） days after operation. The duration of mechanical ventilation was （16.12±14.09） days, 26eases died （38.8%）, and 41 eases （61.2%） were successfully recovered with mechanical ventilation. [Conclusion] After elderly patients in PRF, mechanical ventilation should be applied through the treatment process. In the maintenance of adequate ventilation conditions, the timely processing of the primary disease, an effective infection control, nutritional support positive impact on mechanical ventilation is the key to success factors.

关 键 词：老年人 手术后期间 呼吸衰竭/治疗 通气 

分 类 号：R563.8[医药卫生—呼吸系统]