慢性阻塞性肺疾病肺减容术的围麻醉期处理

目的:探讨慢性阻塞性肺疾病(COPD)肺减容术(LVRS)的围麻醉期处理方法.方法:14例COPD患者接受LVRS.麻醉前先戒烟、消炎、平喘、吸氧、雾化吸入并进行呼吸锻炼,气胸者行闭式引流.静吸复合麻醉(6例复合胸段硬膜外麻醉).术后患者返回监护病房继续吸氧、控制呼吸或无创正压通气(NIPPV),同时雾化吸入、吸痰、镇痛、消炎,恢复后期继续呼吸锻炼.结果:呼吸锻炼后FEV1、FEV1/FVC增加,PaCO2下降, VC、PaO2和SaO2无显著改变.术毕即刻拔管5例(占35.7%),无一例再次插管.患者出院时FEV1、FEV1/FVC和PaO2较入院时均升高,而VC、PaCO2和SaO2无显著改变.14例患者在获不同程度康复后出院.出院后随访,患者生活质量Kamofsky评分有非常显著的提高.结论:充分而细致的围麻醉期处理能使严重COPD患者安全度过手术期,使LVRS的成功率提高.

Perianesthesia management of lung volume reduction surgery for chronic obstructive pulmonary disease

To present the perianesthesia treatment processes of lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease ( COPD) . Methods: Fourteen middle and severe COPD patients were scheduled for selective LVRS. Preoperatively, the following treatments were carried out; giving up smoking, antiinflammation, treating asthma, inhalating oxygen, atomization and breath exercise. Chest closed drainage was presented for the pneu-mothorax patients. Mixed intravenous and inhalation anesthesia were applied. Six of 14 patients were accompanied by the thoracic epidural anesthesia. Postoperatively, inhalating oxygen, atomization, sputum suction, analgesia, infection prevention and controlled respiration or noninvasive positive pressure ventilation ( NIPPV) were applied. Breath exer-cise was scheduled during the anaphase of recovery. Results:After breath exercise, the percentage of predicated value of mean FEV, and FEV1/FVC were increased, the mean PaCO2 was decreased. However, there was no obvious change in VC, PaO2 and SaO2. Tracheal extubation was performed in 5 patients when the operation was completed. No re-intu-bation was required. When discharging from the hospital,the percentage of predicted value of mean FEV1, FEV1/FVC and PaO2 of all patients'were higher than the results before operation. All patients achieved partial recovery. During fol-lowing-up, the mean Kamofsky scores of quality of life had significantly increased in all the 14 patients. Conclusion: Sufficient and meticulous perianesthesia management can make the severe COPD patient getting through the operation safely and increase the successful rate of LVRS.