中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (02): 109-111.

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重视围手术期呼吸系统并发症的预防和处理

吴国豪，庄秋林   

  1. 复旦大学附属中山医院普外科 复旦大学普通外科研究所，上海200032
  • 出版日期:2011-02-01 发布日期:2011-05-30

  • Online:2011-02-01 Published:2011-05-30

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摘要：

围手术期呼吸系统并发症是增加手术死亡率的重要原因之一。其中包括肺炎、肺不张、支气管痉挛、慢性肺病的加重以及呼吸衰竭等；其发生的相关危险因素包括慢性肺病、吸烟、高龄、充血性心功能衰竭等病人因素以及手术部位、手术时间、麻醉方式、急诊手术等手术相关因素。详细询问病史以及仔细体格检查是发现高危病人的重要方法。肺功能测定、摄胸片以及肝肾功能评估也十分重要。围手术期戒烟、营养支持、呼吸功能锻炼、术中良好的麻醉管理等能有效降低围手术期呼吸系统并发症发生率。控制术后疼痛、氧疗以及应用肺膨胀技术是预防和处理呼吸系统并发症的重要措施。

关键词: 围手术期, 呼吸系统并发症, 术前评估

Abstract:

To place importance on prevention and treatment of perioperative respiratory complications        WU Guo-hao, ZHUANG Qiu-lin. Department of General Surgery, Zhongshan Hospital , Fudan University ,Shanghai200032, China
Corresponding  author ：WU Guo-hao, E-mail：prowugh@yahoo.com.cn
Abstract    Postoperative respiratory complications play a significant role in the risk for surgery. The most important and morbid postoperative respiratory complications are atelectasis, pneumonia, respiratory failure and exacerbation of underlying chronic lung disease. Risk factors for postoperative respiratory complications include patient-related risk factors such as chronic lung disease，age，cigarette use，congestive heart failure as well as procedure-related risk factors (e.g. surgical site, duration of surgery, anesthetic technique and emergency surgery). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at risk patients. Pulmonary function tests, X-rays and other related tests also can assess risk of perioperative respiratory complications. Strategies to reduce the risk of perioperative respiratory complications include smoking cessation, pulmonary function training, optimizing nutritional status and intraoperative strategies. Postoperative care should include lung expansion techniques, supplemental oxygen therapy and adequate pain control.

Key words: perioperative peroid, respiratory complications, preoperative evaluation