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。

Perioperative complication and management of patient with high risk COPD following esophagectomy

Objective To discuss perioperative complication and management of patient with high risk COPD following esophagectomy. Methods 45 patients with high risk COPD underwent esophagectomy with epidural block combined with general anesthesia. Perioperative treatment included smoking cessation, chest physiotherapy,prevention and control of infection of air way and appropriate bronchodilators of air way, breathing exercises, nutrition support and oxygen therapy. Painkiller was instilled after surgery, early exercises, ensuring unobstruction of the air way, Mechanical ventilation was applied when needed. Results 3 had hypoxaemia in operation. After surgery, all patients had SpO2 somewhat declined. 6 had lung infection. 6 were removed of bronchial secretion by bronchoscope. 2 were supported by ventilator by using intubation. 2 underwent tracheotomy. 1 had disturbances of acid-base balance and treated by using hydrochloric acid muriatic acid. All patients recovered rather smoothly and discharged from hospital. Conclusion High risk COPD is not the absolute contraindication of esophagectomy. Active management before and after surgery ensures the safety and recovery of patients.