机械通气治疗腹部外科术后急性呼吸衰竭的临床研究

目的探讨腹部外科术后发生急性呼吸衰竭的诱因及影响机械通气疗效的因素。方法回顾性分析91例患者腹部外科术后发生急性呼吸衰竭的基础疾病、诱因及机械通气治疗的效果。结果诱因包括术后发生肺部感染53例，严重腹腔感染或急性重症胰腺炎导致的急性呼吸窘迫综合征(ARDS) 38例。其中合并慢性阻塞性肺病(COPD)38例，重度营养不良32例，低钾血症14例。呼吸衰竭发生在术后(4.08±2.45)d，机械通气维持时间(21.66±21.42)d。死亡33例（36.3%），撤机成功58例（63.7%）。结论腹部外科术后发生急性呼吸衰竭时，应合理实施机械通气并调整撤机策略，避免机械通气依赖。及时处理原发病，有效控制腹腔感染，积极进行对症与支持治疗是影响机械通气成败的因素。

A clinical study of mechanical ventilation in the treatment of acute respiratory failure following abdominal surgery

ObjectiveTo explore the predisposing factors in the development of acute respiratory failure after abdominal surgery and the factors affecting the therapeutic effect of mechanical ventilation. MethodsA retrospective study was undertaken for acute respiratory failure after abdominal surgery in 91 patients. The underline diseases, introducing causes and efficacy of mechanical ventilation were retrospectively analysed. ResultsPostoperative pneumonia was the cause of acute respiratory failure in 53 cases and ARDS caused by severe abdominal infection and severe acute pancreatitis in 38 cases. Of the 91 cases, complicated with COPD in 38 cases, severe malnutrion 32 cases, and hypokalemia 14 cases. Respiratory failure occurred at（4.08±2.45）days after operation. The duration of mechanical ventilation was（21.66±21.42）days; 33 cases died, and 58 cases were successfully recovered with mechanical ventilation.ConclusionsThe management of acute respiratory failure after abdominal asurgery should be rational use of mechanical ventilation, adjustment of weaning strategy and avoidance of dependance on mechanical ventilation. Timely treatment of the primary disease, effective control of abdominal infection and aggressive symptomatic and supportive treatment are factors that affect the success or failure of mechanical ventilation.