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[慢性呼吸衰竭患者术前的呼吸准备]

[Respiratory preparation before surgery in patients with chronic respiratory failure].

作者信息

Delay Jean-Marc, Jaber Samir

机构信息

CHU de Montpellier, hôpital Saint-Éloi, département d'anesthésie-réanimation Saint-Éloi (DAR B), 34295 Montpellier, France.

出版信息

Presse Med. 2012 Mar;41(3 Pt 1):225-33. doi: 10.1016/j.lpm.2011.08.007. Epub 2011 Oct 17.

Abstract

Scheduled and/or thoracic, abdominal surgeries increase the risk of respiratory postoperative complications. In patients with chronic respiratory failure, preoperative evaluation should be performed to evaluate respiratory function in aim to optimize perioperative management. Preoperative gas exchange abnormalities (hypoxemia or hypercapnia) are associated with respiratory postoperative complications. Respiratory physiotherapy and prophylactic non-invasive ventilation should be integrated in a global rehabilitation management for cardiothoracic or abdominal surgery procedures, which are at high risk of postoperative respiratory dysfunction. Stopping tobacco consummation should be benefit, but decease risk of postoperative complications is relevant only after a period for 6 to 8 weeks of cessation. Bronchodilatator aerosol therapy (beta-agonists and atropinics) and inhaled corticotherapy allow a rapid preparation for 24 to 48 h. Systematic preoperative antibiotherapy should not be recommended.

摘要

计划性手术和/或胸腹部手术会增加术后呼吸并发症的风险。对于慢性呼吸衰竭患者,应进行术前评估以评估呼吸功能,旨在优化围手术期管理。术前气体交换异常(低氧血症或高碳酸血症)与术后呼吸并发症相关。呼吸物理治疗和预防性无创通气应纳入心胸或腹部手术的整体康复管理中,这些手术术后呼吸功能障碍风险较高。戒烟应有益处,但仅在戒烟6至8周后,术后并发症的死亡风险才会降低。支气管扩张剂雾化治疗(β受体激动剂和阿托品类药物)和吸入性皮质激素治疗可在24至48小时内快速起效。不建议常规进行术前抗生素治疗。

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