Kösek V, Wiebe K
Sektion für Thoraxchirurgie, Department für Herz- und Thoraxchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1A, 48149, Münster, Deutschland.
Chirurg. 2015 May;86(5):437-43. doi: 10.1007/s00104-014-2865-0.
The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6 ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-20 mmH2O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function.
术后呼吸功能不全的发生通常由多种因素引起，包括与患者相关的风险、手术范围和术后并发症。急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）的发病率和死亡率很高。制定一致的预防策略很重要，术前预处理对于高危患者至关重要。已确诊的术后肺功能衰竭的治疗需要早期气管切开、保护性通气（潮气量6 ml/kg体重）、提高呼气末正压（PEEP，10 - 20 mmHg）、反复支气管镜检查和早期患者活动。在危急情况下，体外肺辅助被认为作为恢复的桥梁和实现保护性通气方案是有益的。有不同的系统，各有不同的适应症。临时应用肺辅助可使呼吸功能不全的患者安全地进行胸外科手术。
