Worth H, Schwalen A
Abteilung für Kardiologie, Pneumologie und Angiologie, MNR-Klinik, Heinrich-Heine-Universität Düsseldorf.
Z Kardiol. 1990;79 Suppl 4:31-8.
Pulmonary complications after cardiac surgery may be caused by preexisting disorders of the respiratory system, common risk factors (e.g., smoking), kind and duration of the surgical procedure, and the anesthesia performed. Preoperative lung function measurements do not allow a valid assessment of the frequency and severity of postoperative complications. However, the efficacy of the peroperative management with bronchodilating agents (beta 2-agonists, theophylline, corticosteroids) in patients with airflow limitation should be based on repeated lung-function testing. After coronary artery surgery, the internal mammary artery grafting produces a greater impairment of lung function than does saphenous vein grafting. In patients with mitral valve disease and pulmonary congestion without increased pulmonary vascular resistance lung-function may be improved by mitral valve replacement. Atelectasis and gas-exchange disturbances during anesthesia can be treated by ventilation with PEEP. An adequate and immediate management of postoperative pulmonary complications (atelectasis, respiratory failure, pneumonia) improves the outcome of patients after cardiac surgery. The role of perioperative physiotherapy for the reduction of pulmonary complications after cardiac surgery is not well established.
心脏手术后的肺部并发症可能由呼吸系统的既往疾病、常见危险因素（如吸烟）、手术的类型和持续时间以及所实施的麻醉引起。术前肺功能测量无法有效评估术后并发症的发生率和严重程度。然而，对于气流受限患者，使用支气管扩张剂（β2受体激动剂、茶碱、皮质类固醇）进行围手术期管理的疗效应基于反复的肺功能测试。冠状动脉手术后，胸廓内动脉移植比大隐静脉移植对肺功能的损害更大。在二尖瓣疾病且有肺淤血但肺血管阻力未增加的患者中，二尖瓣置换术可改善肺功能。麻醉期间的肺不张和气体交换障碍可通过呼气末正压通气进行治疗。对术后肺部并发症（肺不张、呼吸衰竭、肺炎）进行充分且及时的处理可改善心脏手术后患者的预后。围手术期物理治疗在减少心脏手术后肺部并发症方面的作用尚未明确。
