胸外科手术后呼吸衰竭合并支气管胸膜瘘患者的治疗探讨

目的：探讨胸外科手术后急性衰竭合并支气管胸膜瘘患者的临床治疗方法。方法：术后支气管残端瘘１例和肺瘘４例患者均并发急性呼吸衰竭，均需应用呼吸要治疗。支气管残端瘘患者应用呼气末正压通气模式，４例肺瘘虱应用同步间隙指令呼吸模式。结果：应用呼吸机时胸腔引流管均有Ⅱ－Ⅲ度漏气。残端瘘患者由于瘘口较大，大气体由残端瘘口处逸出，引起呼吸机运行不稳定，且动脉血氧饱和度（ＳａＯ２）在氧浓度（ＦｉＯ２）达０．６０时仍

Treatment strategies for postoperative acute respiratory failure accompanying bronchopleural fistula

Objective:To study the treatment methods for postoperative acute respiratory failure accompanying bronchopleural fistula.Methods:5 cases of postoperative bronchopleural fistula requiring mechanic ventilation admitted from Jan.1998 to Jun.1999 were studied.Patients with bronchopleural fistula were treated with positive endexpiratory pressure (PEEP) ventilation.Results:All 5 cases were male,aged 5378 years (average 65 years old).All patients showed escape of large amount of air from the fistula.In spite of the abnormal working condition of the respirator and air escape from the fistula,arterial oxygen saturation(SaO 2) was still maintained at 0 90 to 0 92.After the obliteration of the fistula with an intratracheal balloon,SaO 2 was raised to 0 930 95.The fistula closed spontaneously in 2 patients.The fistula closed up after intrapleural injection of fibrinogen (2 0 g) in the other 2 patients,and no complications arising from ventilatory support or intrathoracic infection occurred.Conclusions:The choice of management methods for fistula depends on their size.There is possibility that a pulmonary fistula closes itself.Nutritional support and aseptic technic in local care should be emphasized.For ventilatory support,modes of the ventilation should be appropriate.