慢性阻塞性肺疾病患者术后肺炎的预防与处理

术后肺炎(postoperative pneumonia,PP)属医院感染性肺炎(院内肺炎),是术后常见的肺部并发症。慢性阻塞性肺疾病(chronic obstructive pul monary disease,COPD)是一种以气流受限为特征的肺部疾病,通常呈进行性发展,不完全可逆,多与肺部对有害颗粒物或有害气体的异常炎症反应有关。由于阻塞性通气功能障碍,合并全小叶肺气肿时尚有弥散量降低,因此,对心肺功能有影响的麻醉和手术均可导致呼吸功能的恶化而使病情加重。由于心肺功能的改变,使麻醉、术前、术后的管理与一般患者不同,应加强围手术期的管理,以减少PP的发生。一、COPD的特点与…     

严重慢性阻塞性肺疾病患者食管切除术围手术期并发症及处理

目的 探讨重度慢性阻塞性肺疾病简称慢阻肺病人食管切除术围手术期常见并发症及其处理。方法 45例重度慢阻肺的病人在全麻联合硬膜外阻滞下进行开胸食管切除手术，围手术期处理包括术前戒烟、胸部理疗、预防和控制呼吸道感染、解痉化痰、呼吸功能锻炼、营养支持和氧疗；术后硬膜外镇痛、早期锻炼、保持呼吸道通畅，部分病人予以呼吸支持。结果 术中3例出现低氧血症。术后所有病人PaO2均有不同程度的下降，6例出现肺部感染，6例行纤维支气管镜吸痰，2例通过气管插管给予呼吸机支持，2例行气管切开术，1例酸碱平衡紊乱使用盐酸精氨酸治疗。所有病人均痊愈出院。结论 重度慢阻肺病人并非开胸食管切除手术的绝对禁忌证，积极的术前准备和严格的术后管理可减少和控制术后急性发作，有助于确保此类病人的围手术期安全和康复。     

慢性阻塞性肺疾病患者疾病不确定感的影响因素分析

目的探讨慢性阻塞性肺疾病（COPD）患者疾病不确定感状况及其影响因素。方法便利抽取52例稳定期COPD患者为研究对象,应用疾病不确定感量表、COPD生存质量测评表测量其疾病不确定感和生存质量,同时测定其肺功能。结果COPD患者的整体疾病不确定感评分为76．30±7．01．生存质量评分为84．17±6．13;病程、疾病分期、婚姻状况、文化程度、生存质量与疾病不确定感有相关（P〈0．05,P〈0．01）。结论COPD患者的疾病不确定感属于中等程度,其不确定感主要来自不明确性;COPD患者的病程、疾病分期、婚姻状况、文化程度、生存质量对疾病不确定感有一定影响。应采取针对性措施改善患者疾病不确定感,提高其生存质量。     

慢性阻塞性肺疾病患者疾病不确定感的影响因素分析

目的 探讨慢性阻塞性肺疾病(COPD)患者疾病不确定感状况及其影响因素.方法 便利抽取52例稳定期COPD患者为研究对象,应用疾病不确定感量表、COPD生存质量测评表测量其疾病不确定感和生存质量,同时测定其肺功能.结果 COPD患者的整体疾病不确定感评分为76.30±7.01,生存质量评分为84.17±6.13;病程、疾病分期、婚姻状况、文化程度、生存质量与疾病不确定感有相关(P＜0.05,P＜0.01).结论 COPD患者的疾病不确定感属于中等程度,其不确定感主要来自不明确性;COPD患者的病程、疾病分期、婚姻状况、文化程度、生存质量对疾病不确定感有一定影响.应采取针对性措施改善患者疾病不确定感,提高其生存质量.     

护理干预对慢性阻塞性肺疾病患者生存质量的影响

将56例慢性阻塞性肺疾病(COPD)患者随机分为对照组和观察组各28例。对照组采用常规护理方法,观察 组在此基础上增加护理干预措施,于5周后采用生存质量测评表(QOL)进行评估。结果观察组日常生活能力、社 会活动情况、抑郁心理状况、焦虑心理症状及QOL总分显著优于对照组(均P<0.05)。提出护理干预能改变不良 的生活方式,预防疾病复发,提高COPD患者的生存质量。     

合并慢性阻塞性肺疾病的食管癌病人围手术期处理

目的　探讨合并慢性阻塞性肺疾病 (CPOD)的食管癌病人的围手术期处理。方法　总结2 18例合并COPD病人行食管癌根治术的手术经验和术后急性呼吸窘迫综合征 (ARDS)的治疗体会。结果　全组无手术中死亡。吻合口漏致全身感染死亡 2例 ,术后发生ARDS 2 6例 ,死亡 7例。结论　术前严格的检查有助于判断COPD程度 ,及早发现和及时处理是ARDS治疗成功的关键 ,除病因治疗和脏器功能维持外 ,更重要的是以全身炎症反应综合征 (SIRS)与代偿性抗炎反应综合征 (CARS)为主线 ,积极干预 ,可提高成功率     

慢性阻塞性肺疾病的外科治疗进展

有严重呼吸困难症状的晚期慢性阻塞性肺疾病单纯内科治疗效果不佳 ,目前常用的外科治疗方法有肺大疱切除、肺移植和肺减容术 (LVRS)。但每一术式均有其优缺点 ,应严格掌握手术的适应证和禁忌证。肺大疱切除术 ,是有症状的巨大肺大疱和肺大疱引起反复气胸的首选术式。LVRS的理想指征是过度气肿 ,非均质病变 ,FEV1>2 0 %和正常的PaCO2 。而弥漫性病变、低FEV1、高碳酸血症、合并肺动脉高压则首选肺移植术     

口服罗红霉素对慢性阻塞性肺疾病患者肺功能的影响

目的探讨口服罗红霉素对慢性阻塞性肺疾病（COPD）患者肺功能的影响,并分析其可能的机制。方法将50例COPD患者采用随机、单盲方法分成治疗组25例与对照组25例,其中对照组采用常规基础治疗,治疗组在常规基础治疗基础上口服罗红霉素0．15g,2次／d,并持续1年。观察两组患者治疗前后外周血中性粒细胞计数及肺功能的变化,统计分析两组患者发生病情急性加重及因此而需住院的次数。结果治疗组患者治疗前后外周血中性粒细胞计数差异有统计学意义（P〈0．05）;治疗组第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1％预计值）、最大通气量、清晨最大呼气流量治疗前后改变不明显（P〉0．05）,对照组却有明显下降（P〈0．05）,两组患者治疗前后肺功能的变化差异有统计学意义（P〈0.05）;治疗组急性加重10例次（40％）,对照组19例次（76％）;治疗组需住院6例次（24％）,对照组13例次（52％）,两组急性加重率及需住院率比较差异均有统计学意义（P〈0．05）。结论口服罗红霉素对COPD患者肺功能具有保护作用,其可能的机制与罗红霉素对中性粒细胞的抑制作用有关。     

呼气末正压对慢性阻塞性肺疾病患者肾功能的影响

呼气末正压( peep)对慢性阻塞性肺疾病伴发Ⅱ型呼吸衰竭患者的肾功能影响.方法:将我院2006年4月- 2011年10月来收治的COPD急性加重期伴发Ⅱ型呼吸衰竭,且需应用机械通气的患者80例进行研究.将患者随机分为两组,两组患者均给予常规的抗感染、解痉、平喘、机械通气治疗,一组未应用PEEP,作为对照组,另一组应用PEEP(4 ～ 10 cmH20)为观察组.观察和比较两组应用机械通气24小时后的尿量、尿素、肌酐清除率结果:80例患者应用机械通气后,仅有75例进入研究分析.观察组应用机械通气后因病情危重有3例死亡,应用机械通气未满24小时.对照组应用机械通气后因病情危重有2例死亡,应用机械通气未满24小时2例死亡.治疗24小时后,观察组尿量、尿素清除率、肌酐清除率对比对照组均明显下降.观察组有5例发生肾功能衰竭,对照组有2例发生肾功能衰竭,其中尿量,尿素清除率、肌酐清除率在两组对比时发现均有统计学意义.而发生肾功能衰竭的患者在两组间对比无统计学意义.结论:COPD伴发Ⅱ呼吸衰竭的患者,应用机械通气时,PEEP的应用可影响患者的肾功能,使患者的尿量、尿素、肌酐清除率明显下降.     

麻醉药物对成人患者心脏术后肺部并发症的影响

目的 评估术中麻醉维持药物(吸入麻醉药或静脉麻醉药)对体外循环下成人心脏手术患者术后肺部并发症(postoperative pulmonary complications,PPCs)的影响.方法 从四川大学华西医院电子病历信息管理系统及麻醉手术临床信息系统中回顾性筛选2018年9月至2019年2月194例行择期体外循环...     

Evaluation of the risk of postoperative pulmonary complications

Ten of 40 patients who underwent major thoracic or abdominal operations developed postoperative pulmonary complications, consisting of six massive atelectasis, three pneumonias and one edema. They were mostly thoracotomy cases and cigarette smokers. Many of these complications would have been prevented, if reliable pulmonary function tests are available to predict preoperatively such occurrence. Flow-volume curve tracing and closing volume measurement were evaluated in this respect. Both flow at the point of functional residual capacity on flow-volume curve, and the closing capacity subtracted from functional residual capacity were found to be well correlated with the occurrence of postoperative complications and can be used to evaluate the risk of pulmonary complications developing in postoperative period.     

盐酸戊乙奎醚对慢性阻塞性肺病病人呼吸力学参数的影响

目的研究应用盐酸戊乙奎醚对慢性阻塞性肺病(chronic obstructive pulmonary dis-ease,COPD)病人气管内插管应用呼吸机后呼吸力学参数的影响。方法COPD病人66例随机均分为两组:盐酸戊乙奎醚组(Ⅰ组):气管插管应用呼吸机前静注盐酸戊乙奎醚1mg;对照组(Ⅱ组):不给予任何支气管扩张药物。分别观察并监测气管内插管应用呼吸机后1、4和6h的呼吸力学参数(气道压力、气道阻力和胸肺顺应性)。结果Ⅰ组各个时间点的气道峰压、气道平台压以及气道阻力明显低于Ⅱ组(P<0.05),而胸肺顺应性明显高于Ⅱ组(P<0.05)。结论盐酸戊乙奎醚可明显降低COPD病人气管内插管后的气道压力和气道阻力,增加胸肺顺应性。     

Characteristics and long-term outcome of acute exacerbations in chronic obstructive pulmonary disease: an analysis of cases in the Swedish Intensive Care Registry during 2002-2006

Background: Chronic obstructive pulmonary disease (COPD) represents a major and growing health problem. The purpose of this work was to examine characteristics, resource use and long-term survival in patients with an acute exacerbation of COPD that were admitted to Swedish intensive care units (ICU).
Methods: Patient characteristics at admission, length of stay (LOS), resource use and outcome were collected for admissions due to COPD during 2002–2006 in the database of the Swedish Intensive Care Registry. Vital status was secured for 99.6% of the patients. Kaplan–Meier survival estimates were computed for index admissions only.
Results: We identified 1009 patients with 1199 admissions due to COPD (1.3% of all intensive care admissions). The mean (SD) age was 70.2 (9.1) years and the proportion of women were 61.5%. Mean (SD) Acute Physiology and Chronic Health Evaluation II probability of hospital death was 0.31 (0.19). Median LOS was 28 (interquartile range 52) h. The number of readmissions was 190 during the 5-year study. Older patients had fewer readmissions (OR 0.96, 95% CI: 0.95–0.98/year increase in age). ICU mortality was 7.3% (87 of 1199 admissions) and 30-day mortality was 26.0% (262 of 1009 index admissions). Median survival was 14.5 months and 31% of patients survived 3 years after the index admission.
Conclusions: Short (30 days) and long-term survival is poor in acute COPD. Readmissions are frequent reflecting the severity of this chronic illness. Patients are less likely to be readmitted with increasing age which may be due to withholding of further intensive care.     

Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease

Objective: The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods: Prospectively, 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (Rehab. Group). The criteria of COPD were preoperative forced expiratory volume in 1 second (FEVl)/forced vital capacity (FVC) ≦70% and more than 50% of low attenuation area in a computed tomography. Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively. As a historical control, 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 (control group) were entered in this study. Results: Patient backgrounds were all equivalent between the two groups. However, FEV1 and FEV1/FVC were significantly lower in the Rehab. Group (p<0.05). Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group. The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab. Group (p=0.047). Furthermore, postoperative hospital stay was significantly longer in the control group (p=0.0003). Conclusion: Despite lower FEV1 and FEV1/FVC in the Rehab. Group, postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy.     

Prevalence of vertebral fractures among patients with chronic obstructive pulmonary disease in Canada

Purpose: Patients with chronic obstructive pulmonary disease (COPD) may be at higher risk for osteoporosis. The primary objective of this case-control study was to determine the prevalence of vertebral fractures among patients with COPD admitted to acute care compared with a gender- and age-matched control group. Subjects and methods: Subjects were identified by chart reviews from an acute care hospital in Hamilton, Ontario, in 1999, including patients who were over 50 years old. In total, 127 patients with ICD-9 codes specifying COPD were randomly selected and compared with 127 gender- and age-matched controls. Chest radiographs were interpreted by two radiologists who defined and graded vertebral fractures using Genants method. Medications taken, or prescribed at discharge, were recorded from charts. Results: The overall prevalence of at least one vertebral fracture was found to be 34/127 (26.8%) in the COPD patients compared with 30/127 (23.6%) in the controls (p=0.556). A significantly greater proportion of COPD patients had at least one severe vertebral fracture (OR=3.75, 95% CI 1.24 to 11.3). Review of hospital chest X-ray reports indicated that only 12 of 64 (18.8%) patients with vertebral fractures identified by the study radiologists actually had a vertebral fracture noted in the report. The proportion of COPD patients with vertebral fractures who were discharged on osteoporosis therapy was 5/27 (18.5%). There was a suggestion of lower lung function, as measured by forced vital capacity (FVC%), in patients with severe vertebral fractures (p=0.067). Conclusions: These data indicate that: (1) There is an increased proportion of COPD patients with severe vertebral fracture, and (2) Documentation and treatment of osteoporosis in acute care COPD patients is low. Therefore, there is a need to target this high-risk group for osteoporosis screening and potential clinical management.This study was supported by a research grant from Procter & Gamble Pharmaceuticals.     

结直肠癌合并慢性阻塞性肺疾病患者的临床分析

目的 探讨结直肠癌合并慢性阻塞性肺疾病(COPD)患者手术治疗的危险性、手术耐受力及围手术期的处理.方法 收集广西医科大学第一附属医院2005年7月至2008年7月结直肠癌合并COPD患者的临床资料共40例.并收集无COPD的结直肠癌老年患者40例,对手术后常见并发症进行对比分析.结果 合并COPD与无COPD的结直肠癌患者出现伤口裂开分别为2例和1例、伤口感染为3例和7例,肺部感染14例和6例(P<0.05),呼吸衰竭8例和2例(P<0.05).术后住院时间:COPD组中＜ 14 d占5例,14～21 d占24例,＞21 d占7例.对照组中＜ 14 d占9例,14～21 d占29例,＞21 d占3例.结论 结直肠癌合并COPD患者手术危险性高,主要在术后,但术前、术中与术后进行适当的准备与处理,可降低术后并发症发生.     

阻塞性肺疾病危险因素与术后肺部并发症关系的研究

目的分析围手术期合并慢性阻塞性肺疾病(COPD)者的自身因素、手术因素与手术后肺部并发症(PPC)发生的关系及术前各项肺功能指标和动脉血氧分压(PaO2)与PPC的关系。方法对2002年9月至2004年11月中国医科大学附属第一医院重症医学科收治的54例围手术期COPD病人按年龄、体重指数(BMI)、手术时间及手术部位分别分组,对不同组间PPC的发生率进行χ2检验;利用SPSS11.12统计软件对术前动脉血氧分压(PaO2)和肺功能指标与PPC间的关系、对术前动脉血氧分压(PaO2)和肺功能指标与术后机械通气(MV)时间的关系进行多元相关分析。结果54例病人中30例(55.6%)发生PPC。年龄>70岁组与年龄≤70岁组的PPC发生率差异无显著性意义;BMI≥24组的PPC发生率显著高于BMI<24组;手术时间≥2h组的PPC发生率显著高于<2h组;上腹部手术组PPC的发生率显著高于下腹部组。术前PaO2和各肺功能指标与PPC的发生呈负相关趋势;而肺通气功能的各项指标与术后机械通气(MV)时间也呈负相关趋势。结论围手术期COPD病人,BMI≥24、手术时间≥2h者,上腹部手术者,术前肺通气功能较差者,PPC的发生率高;术前阻塞性肺通气功能障碍越重,MV时间越长。