Weissman Charles
Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University School of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Semin Cardiothorac Vasc Anesth. 2004 Sep;8(3):185-211. doi: 10.1177/108925320400800303.
Over the past two decades there has been a steady evolution in the practice of adult cardiac surgery with the introduction of "off-pump" surgery. However, respiratory complications remain a leading cause of postcardiac surgical morbidity and can prolong hospital stays and increase costs. The high incidence of pulmonary complications is in part due to the disruption of normal ventilatory function that is inherent to surgery in the thoracic region. Furthermore, patients undergoing such surgery often have underlying illnesses such as intrinsic lung disease (e.g., chronic obstructive pulmonary disease) and pulmonary dysfunction secondary to cardiac disease (e.g., congestive heart failure) that increase their susceptibility to postoperative respiratory problems. Given that many patients undergoing cardiac surgery are thus susceptiple to pulmonary complications, it is remarkable that more patients do not suffer from them during and after cardiac surgery. This is to a large degree because of advances in anesthetic, surgical and critical care that, for example, have reduced the physiological insults of surgery (e.g., better myocardial preservation techniques) and streamlined care in the immediate postoperative period (e.g., early extubation). Moreover, the development of minimally invasive surgery and nonbypass techniques are further evidence of the attempts at reducing the homeostatic disruptions of cardiac surgery. This review examines the available information on the incidences, consequences, and treatments of postcardiac surgery respiratory complications.
在过去二十年中，随着“非体外循环”手术的引入，成人心脏手术实践有了稳步发展。然而，呼吸并发症仍然是心脏手术后发病的主要原因，会延长住院时间并增加费用。肺部并发症的高发生率部分归因于胸部手术固有的正常通气功能的破坏。此外，接受此类手术的患者通常患有潜在疾病，如内在肺部疾病（如慢性阻塞性肺疾病）和继发于心脏病的肺功能障碍（如充血性心力衰竭），这增加了他们术后发生呼吸问题的易感性。鉴于许多接受心脏手术的患者易患肺部并发症，值得注意的是，更多患者在心脏手术期间和术后并未遭受此类并发症。这在很大程度上归功于麻醉、外科和重症监护方面的进展，例如，这些进展减少了手术的生理损伤（如更好的心肌保护技术），并简化了术后即刻的护理（如早期拔管）。此外，微创手术和非体外循环技术的发展进一步证明了为减少心脏手术对体内平衡的破坏所做的努力。本综述探讨了有关心脏手术后呼吸并发症的发生率、后果及治疗的现有信息。
