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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)。全肺切除尤其是右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 analyze the causes of postoperative respiratory failure in lung cancer and to explore its prevention and treatment. Methods The incidence of postoperative respiratory failure in 659 lung cancer patients from January 2000 to December 2006 was retrospectively reviewed. The preoperative pulmonary function, past medical history, causes of respiratory failure, preventive measures and treatment were analyzed in order to Clinical reference. Results Of the 659 patients, 42 patients developed respiratory failure, the incidence of 6.4%, all occurred in 1 ~ 5 days after operation. Respiratory tract infections, bronchial asthma, surgical trauma, incision pain stimulation, preoperative cardiopulmonary dysfunction is the main cause of postoperative respiratory failure. Among the 42 cases, 37 cases were controlled by respiratory ventilator and symptomatic treatment of respiratory failure, 2 cases died of respiratory failure after multiple organ failure, 2 died of respiratory distress syndrome, 1 died of severe respiratory tract infection and died Rate of 11.9%. Patients with respiratory failure before lung function index were significantly lower than those without respiratory failure (P <0.01). The incidence of respiratory failure after pneumonectomy, especially right pneumonectomy, was significantly higher than that of lung lobectomy and lung wedge resection (P <0.01). Conclusion Respiratory failure is one of the most common perioperative complications of lung cancer. It has high mortality, difficult treatment, early diagnosis and prompt mechanical ventilation. It is the most effective way to rescue the patients and enhance perioperative respiratory management and avoid the complications Disease is the key to prevention. To investigate the causes and characteristics of postoperative respiratory failure in lung cancer and to take effective prevention and treatment measures are of clinical importance.