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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

20卷

期数:

2014年01期

页码:

48-050

栏目:

临床医学

出版日期:

2014-01-20

文章信息/Info

Title:

Comparative study on different treatments of postoperative acute respiratory failure by thoracotomy in elderly patients

文章编号:

1006-8147(2014)01-0048-03

作者:

郭 峰¹; 张 鹏²

(1.天津医科大学研究生院,天津 300070;2.天津医科大学总医院心胸外科,天津 300052)

Author(s):

GUO Feng¹;  ZHANG Peng²

(1.Graduate School, Tianjin Medical University, Tianjin 300070,China;2.Department of Cardiothoracic Surgery, General Hospital, Tianjin Medical University, Tianjin 300052,China)

关键词:

老年患者; 开胸手术; 术后呼吸衰竭; 气管插管; 气管切开; 机械通气

Keywords:

elder patients;  thoracotomy;  postoperative acute respiratory failure; trachea cannula; tracheotomy; mechanical ventilation

分类号:

R61

DOI:

-

文献标志码:

A

摘要:

目的:比较老年患者在开胸术后发生急性呼吸衰竭后常规气管插管与气管切开两种治疗方案的优劣性。方法:选取开胸术后发生急性呼吸衰竭的老年患者41例, 按常规气管插管与气管切开分为两组,其中气管插管组患者24例，气管切开组患者17例，两组患者均予Drager4呼吸机辅助机械通气,同时予原发疾病治疗、抗感染治疗和营养支持治疗等。观察两组患者氧分压(PaO₂)变化、人机对抗和呼吸机相关性肺炎发生率及死亡率。结果:气管切开较气管插管更能有效的改善急性呼吸衰竭患者的氧分压，且人机对抗和呼吸机相关性肺炎发生率及死亡率低于气管插管组。结论:对于术前合并异常肺功能的老年患者术后发生呼吸衰竭时应积极行气管切开，行机械通气治疗，并积极治疗原发疾病, 采用有效抗生素和营养支持。

Abstract:

 Objective: To evaluate the performances of trachea cannula and tracheotomy in the process of treatment of postoperative acute respiratory failure by thoracotomy in elderly patients. Methods: Forty-one elderly patients of postoperative acute respiratory failure by thoracotomy from January 2012 to April 2013 were selected and were divided into two groups: trachea cannula group (24 cases) and tracheotomy group (17 cases). Respiratory support for all these patients were with Drager4 breathing machine. Meanwhile, primary disease treatment, anti-infective therapy and nutrition support therapy were emphasized. The variation of PaO₂, the rate of man-machine confrontation and ventilator-associated pneumonia and death rate were observed . Results: Tracheotomy could effectively improve the variation of PaO_2, the rate of man-machine confrontation and ventilator-associated pneumonia and  death rate of tracheotomy group was lower than that of the trachea cannula group. Conclusion: Early respiratory support with tracheotomy plays a positive role in the treatment of postoperative acute respiratory failure by thoracotomy in elderly patients.

参考文献/References:

[1]杨再明.老年人胸部手术后呼吸衰竭的临床分析[J].中国健康月刊，2011,30（7）：89
[2]许建,高天华.胸部手术后早期低氧血症的处理[J].中华胸心血管外科杂志，2008, 12(9):168
[3] Safdar N, Dezfulian C, Collard H R,et al. Clinical and economic consequences of ventilator-pssociated peumonia:a systematic review[J]. Crit Care Med, 2005,33(10):2184
[4]周超,孙耕耘.呼吸机相关性肺炎诊断进展[J].中华肺部疾病杂志，2009,2(1):53
[5]Janssens J P, Pache J C, Nicod L P. Physiological changes in respiratory function associated with ageing [J]．Eur Respir J,1999,13(1):197
[6]Ikeda A, Isono S, Sato Y, et al Effects of muscle relaxants on mask ventilation in anesthetized persons with normal upper airway anatomy[J]. Anesthesiology, 2012,117(3):487
[7]Cannesson M, Collange V, Lehot JJ. Anesthesia in adult patients with congenital heart disease[J]. Curr Opin Anaesthesiol,2009,22(1):88
[8] Elpern E,?Killeen K,?Patel G, et al. The Application of intermittent pneumatic compression devices for thromboprophylaxis : AN observational study found frequent errors in the?application?of these mechanical?devices?in ICUs[J]. Am J Nurs, 2013, 113(4):30
[9]Watkins S C, McNew M S, Donahue B S. Risks of noncardiac operations and other procedures in children with complex congenital heart disease[J]. Ann Thorac Surg, 2013,95(1):204
[10]黄竹影.气管切开并发肺部感染的原因分析及护理体会[J].局解手术学杂志，2005,14(6):390
[11]Priebe H J. Ventilation before paralysis [J]. Anesthesiology,2013,118(4):992
[12]Derek C. When should a mechanically ventilated patiwnt undergo tracheostomy [J].JAMA,2013,309(20):2163

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备注/Memo

备注/Memo:

作者简介 郭峰(1987-)，男，硕士在读，研究方向：心胸外科；
通信作者：张鹏，E-mail: zhangpzyyxw@163.com。

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更新日期/Last Update: 2014-03-28