Vaca K J, Osterloh J F, Daake C J, Noedel N R
Division of Cardiothoracic Surgery, St Louis University Health Sciences Center, Mo, USA.
Am J Crit Care. 1996 Nov;5(6):412-9.
Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy.
The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients.
An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables.
At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied.
There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients.
目前正在评估几种通过手术增强肺功能和改善大疱性肺气肿患者生活质量的方法。其中一种方法是肺减容术，适用于药物治疗无法有效控制的大疱性肺气肿患者。
本文重点回顾在终末期肺气肿治疗中使用内镜缝合器经单侧胸腔镜进行肺大疱切除术，并探讨这些患者的护理。
采用实验性研究，包括文献回顾以及对术前和术后变量进行卡方检验和t检验分析的临床经验分析。
在3个月的随访中，比较术前和术后参数时，一秒用力呼气量、用力肺活量、分钟通气量、氧分压、残气量和6分钟步行距离均有显著改善。手术死亡率为4%，最常见的并发症是持续性漏气，在所研究的患者中发生率为30%。
现在有一致的初步信息支持肺减容术能在相当比例的患者中改善肺功能和生活质量这一观点。
