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目的探讨开胸术后呼吸衰竭的发生原因及治疗方法。方法报告20例开胸术后呼吸衰竭患者,其中食管癌根治术9例,肺切除术10例,胸外伤并支气管破裂1例。呼吸衰竭发生时间在术后2～5 d,Ⅰ型呼吸衰竭6例,Ⅱ型呼吸衰竭14例。呼吸衰竭发生后均采用机械通气治疗,呼吸模式为容量控制或同步间歇指令呼吸(simv)。辅助呼吸时间2～8 d,平均3.5 d。结果本组死亡3例,死亡率15%。其中1例为呼吸窘迫综合症(ARDS),另2例为严重肺部感染并多脏器功能衰竭。结论胸手术应重视围手术期的准备,一旦发生呼吸衰竭,及时地机械通气是抢救成功的主要措施之一。
Objective To investigate the causes and treatment of respiratory failure after thoracotomy. Methods Twenty patients with respiratory failure after thoracotomy were reported. Among them, there were 9 cases of radical resection of esophageal carcinoma, 10 cases of pneumonectomy, and 1 case of thoracic trauma and bronchial rupture. Respiratory failure occurred in 2 ~ 5 days after surgery, 6 cases of type Ⅰ respiratory failure, 14 cases of type Ⅱ respiratory failure. Respiratory failure occurred after treatment with mechanical ventilation, breathing mode for volume control or synchronized intermittent mandatory breath (simv). Assisted breathing time 2 ~ 8 d, an average of 3.5 d. Results The group died in 3 cases, the mortality rate was 15%. One case of respiratory distress syndrome (ARDS), the other two cases of severe pulmonary infection and multiple organ failure. Conclusions Thoracic surgery should pay more attention to perioperative preparation. Once respiratory failure occurs, timely mechanical ventilation is one of the main measures for successful rescue.