结核性毁损肺胸膜全肺切除术后在重症加强治疗病房中的救治分析  

Postoperative Treatment of Pleuropneumonectomy for Tuberculosis Destroyed Lung in Intensive Care Unit

作　　者：康乃民[1] 张秀娟 

机构地区：[1]首都医科大学附属北京胸科医院ICU,北京101149 [2]北京市通州区新华医院内科,北京101100

出　　处：《中国呼吸与危重监护杂志》2011年第6期586-589,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨结核性毁损肺患者接受单侧胸膜全肺切除术后在重症加强治疗病房(ICU)中的救治过程,以提高此类患者围术期的救治水平。方法回顾性分析2008年6月至2010年6月52例结核性毁损肺患者接受单侧胸膜全肺切除手术后在ICU中的救治情况。术后ICU常规治疗。有针对性的治疗,如术后出血的监测和治疗,术后纤维支气管镜主动吸痰及检查,术后并发急性呼吸衰竭患者采取有创-无创序贯机械通气治疗策略纠正急性呼吸衰竭。结果 52例结核性毁损肺患者接受胸膜全肺切除术,术后活动性出血11例,经ICU综合救治,活动性出血逐渐停止,无术后出血死亡病例。术后有8例患者出现急性呼吸衰竭,经过有创-无创序贯机械通气治疗,呼吸衰竭救治顺利,无因术后急性呼吸衰竭死亡病例。结论结核性毁损肺接受胸膜全肺切除患者ICU救治术后活动性出血取得良好效果,主动应用纤维支气管镜检查并吸痰,并对术后合并急性呼吸衰竭患者应用有创-无创序贯机械通气治疗,临床救治效果明显。ICU综合救治措施为此类患者围术期恢复提供了保障。Objective To investigate the postoperative treatment of pleuropneumonectomy for tuberculosis destroyed lung in ICU,in order to improve the therapeutical efficacy for these patients.Methods Clinical data of 52 patients who suffered from tuberculosis destroyed lung and underwent pleuropneumonectomy from June 2008 to June 2010 were analyzed retrospectively.All of subjects received routine treatment in ICU after the operation.Meanwhile,appropriate targeting treatments were applied including diagnosis and treatment of postoperative bleeding,application of fiberbronchoscope to aspirate the sputum after the operation,sequential non-invasive ventilation after the invasive ventilation for acute respiratory failure after operation,etc.Results A total of 52 patients received the pleuropneumonectomy operation.Bleeding occurred in 11 cases after operation and stopped after the integrated therapy.8 patients suffered from acute respiratory failure and attenuated after sequential ventilation.No patients died for postoperative bleeding or acute respiratory failure.Conclusions Patients who suffered from tuberculosis destroyed lung and received pleuropneumonectomy with postoperative bleeding and acute respiratory failure have a good prognosis after appropriate postoperative treatment in ICU.

关 键 词：结核性毁损肺 胸膜全肺切除 治疗 重症加强治疗病房 

分 类 号：R655.3[医药卫生—外科学]