CAJ | 학술논문

目的：总结慢性阻塞性肺疾病(COPD)患者在电视胸腔镜(VATS)下行肺减容术的围术期处理的问题。方法：该组7例均为男性，年龄65～76岁，按“慢性阻塞性肺疾病诊治规范(草案)”的气急分级标准，其中属4级4例，属3级3例。FEV1均小于50%(三级)。全组均有胸部CT显示上肺及肺周边有小而均匀之肺靶区。选择估计对肺功能影响较大的一侧肺先行手术，切除肺容量为术侧的20%～30%。结果：7例中术后有哮喘性支气管炎发作致呼吸困难3例，其中需行气管切开2例(均未用呼吸机)，1例因咳嗽频繁剧烈致肺泡漏气，胸管引流48h内拔除胸腔引流管。术后需继续吸氧6d 5例，吸氧8d 2例。全部临床症状明显改善，与术前相比FEV1上升30%～45%，气急指数上升1～2级，均步行出院。结论：术前调节水电解质平衡，进行适当的呼吸运动训练，以及术后合理的氧疗法，保持呼吸道通畅，提高呼吸功率等是至关重要的。在紧急情况下应果断行气管切开术。
목적：총결만성조새성폐질병(COPD)환자재전시흉강경(VATS)하행폐감용술적위술기처리적문제。방법：해조7례균위남성，년령65～76세，안“만성조새성폐질병진치규범(초안)”적기급분급표준，기중속4급4례，속3급3례。FEV1균소우50%(삼급)。전조균유흉부CT현시상폐급폐주변유소이균균지폐파구。선택고계대폐공능영향교대적일측폐선행수술，절제폐용량위술측적20%～30%。결과：7례중술후유효천성지기관염발작치호흡곤난3례，기중수행기관절개2례(균미용호흡궤)，1례인해수빈번극렬치폐포루기，흉관인류48h내발제흉강인류관。술후수계속흡양6d 5례，흡양8d 2례。전부림상증상명현개선，여술전상비FEV1상승30%～45%，기급지수상승1～2급，균보행출원。결론：술전조절수전해질평형，진행괄당적호흡운동훈련，이급술후합리적양요법，보지호흡도통창，제고호흡공솔등시지관중요적。재긴급정황하응과단행기관절개술。
Objective:To evaluate the preoperative and postoperative management in lung volume reduction surgery for patients with chronic obstructive pulmonary disease.Methods:All 7 patients were male.Age ranged from 65～76 years.Preoperative dyspnea index was grade 4 in 4 and grade 3 in 3.FEV1 were all less than 50%.We performed unilateral Lung volume reduction surgery on the lung that was estimated to have poorer lung function.The resected lung volume was 20%～30% of the operated.Results:2 tracheotomy were performed.Postoperative oxygen supply lasted 6～8d.The symptoms such as palpitaion,dyspnea were improved significantly.FEV1 and dyspnea index were respectively increased by 30%～45% and 1～2 grade.All patients recovered.Conclusions:Preoperative adjustment of the balance of water and electrolyte,proper respiratory exercises,resasonable postoperative oxygn supply and maintenance of unobstructed respiratory tract,all these are important.Moreover,tracheotomy shoulde be perfored promptly in acute cases.