重症肺大疱的手术治疗分析.docxVIP

重症肺大疱的手术治疗分析 中国编辑。 作者：李英杰，李捷，于长海，俞建琦，张文，夏晖 【摘要】 目的 总结 重症肺大疱的手术 治疗 经验。方法 本组患者共计19例，男性15例，女性4例，术前根据影像学检查及辅助检查证实均属重症肺大疱。术前准备包括吸氧、抗感染、平喘、呼吸训练等。手术麻醉均采用双腔管、吸入加静脉复合麻醉。所有患者均常规开胸行标准肺大疱切除术，15例患者术后出现呼吸衰竭，给予辅助机械通气，1例患者行气管切开。结果 19例患者痊愈出院，恢复期12~2d，术后自主症状及血气分析结果较术前均有明显改善。结论 重症肺大疱患者术前病情重，掌握手术适应证十分重要；手术后发生呼吸衰竭的概率较高，应尽早给予辅助通气，多数患者恢复良好。  【关键词】 重症肺大疱；肺大疱切除术；呼吸衰竭  Abstract： Objective To discuss the experience in surgical treatment of gravis pulmonary bulla and in management during peri-operation. Methods A total of 1patients (1males, females) were confirmed as gravis pulmonary bulla according to chest imaging and other accessory examinations. The preoperative preparation, such as oxygen uptake, antibiotic therapy, relief of asthma, respiratory exercise, et al, was done. All the patients accepted standard bullectomy under general anesthesia except two patients who recEived chest drainage during the anesthesia because of the spontaneous pneumothorax. Ventilators were applied to 1patients for respiratory failure after operation, and one patient recEIved tracheotomy. Results All the patients were discharged about 12-2days after operation, and the symptoms and the blood gas analysis outcomes were all improved greatly compared with that before operation. Conclusion It is very important to perform operation carefully for the patients with gravis pulmonary bulla as the symptoms worsen. Most of the patients who received operation recover well. Ventilators should be prepared for the high possibility of respiratory failure after operation. The earlier the ventilation, the better the prognosis.  Key words： gravis pulmonary bulla; operation; respiratory failure  重症肺大疱患者多数主观症状重，常可因术前突发的气胸及术后的呼吸循环衰竭而致死，因而成为胸外科临床的一个难题。1996年以来我院收治19例重症肺大疱患者，现将有关手术及围手术期治疗总结报告如下。  1 资料与方法  一般资料 1996年8月—XX年7月本院收治肺大疱患者92例，我们根据患者的病史、临床症状、查体以及辅助检查的结果，在入选的重症肺大疱患者23例中，19例行开胸手术治疗，其中男性15例，女性4例，年龄31~75岁，病史6月~20年。  临床表现 全组病例均主诉胸痛、胸闷、气短、喘憋等，有严重呼吸障碍，丧失劳动能力，有7例患者