摘要
目的：探讨胸外科手术后急性呼吸衰竭合并支气管胸膜瘘患者的临床治疗方法。方法：术后支气管残端瘘１ 例和肺瘘４ 例患者均并发急性呼吸衰竭，均需应用呼吸机治疗。支气管残端瘘患者应用呼气末正压通气模式，４ 例肺瘘患者应用同步间隙指令呼吸模式。结果：应用呼吸机时胸腔引流管均有Ⅱ～Ⅲ度漏气。残端瘘患者由于瘘口较大，大部分气体由残端瘘口处逸出，引起呼吸机运行不稳定，且动脉血氧饱和度（ＳａＯ２）在氧浓度（ＦｉＯ２ ）达０．６０时仍持续于０．９０～０．９２。试用气管内球囊封堵瘘口后使ＳａＯ２ 达０．９３～０．９５。２例肺瘘自动闭合；另２例亦经胸内注入纤维蛋白原２．０ ｇ 后封闭肺瘘口，均未致其他呼吸支持并发症或胸腔感染。结论：瘘口大小决定处理重点，对较大支气管瘘，应先保证气道闭合性；术后肺瘘亦有自愈的可能；术后注重营养支持，引流管的局部护理应严格无菌操作；合理选择呼吸机参数。
Objective:To study the treatment methods for postoperative acute respiratory failure accompanying bronchopleural fistula.Methods:5 cases of postoperative bronchopleural fistula requiring mechanic ventilation admitted from Jan.1998 to Jun.1999 were studied.Patients with bronchopleural fistula were treated with positive endexpiratory pressure (PEEP) ventilation.Results:All 5 cases were male,aged 5378 years (average 65 years old).All patients showed escape of large amount of air from the fistula.In spite of the abnormal working condition of the respirator and air escape from the fistula,arterial oxygen saturation(SaO 2) was still maintained at 0 90 to 0 92.After the obliteration of the fistula with an intratracheal balloon,SaO 2 was raised to 0 930 95.The fistula closed spontaneously in 2 patients.The fistula closed up after intrapleural injection of fibrinogen (2 0 g) in the other 2 patients,and no complications arising from ventilatory support or intrathoracic infection occurred.Conclusions:The choice of management methods for fistula depends on their size.There is possibility that a pulmonary fistula closes itself.Nutritional support and aseptic technic in local care should be emphasized.For ventilatory support,modes of the ventilation should be appropriate.
出处
《中国危重病急救医学》
CAS
CSCD
2000年第1期39-41,共3页
Chinese Critical Care Medicine
关键词
肺部疾病
支气管胸膜瘘
呼吸功能不全
机械通气
pulmonary disease
bronchial fistula
respiratory insufficiency
mechanic ventilation
