Massard G, Wihlm J M
Department of Cardiothoracic Surgery, Université Louis Pasteur, Strasbourg, France.
Chest Surg Clin N Am. 1998 Aug;8(3):503-28, viii.
Postoperative atelectasis is a common problem following any surgery. Limited atelectasis is usually well-tolerated and easily reversible. However, complete atelectasis of the remaining lung following partial lung resection may be poorly tolerated. Thoracic surgical procedures increase the risk because pain, thoracic muscle injury, chest wall instability, and diaphragmatic dysfunction impair clearance of secretions by cough. In addition, patients with lung diseases are prone to increased bronchial secretions. Prophylaxis includes preoperative and postoperative physiotherapy and medications, which should be graded in accordance to the individual patient's risk factors. Large atelectasis requires bronchoscopy to remove mucous plugs. Tracheostomy should be considered in patients with relapsing atelectasis or swallow disorders.
术后肺不张是任何手术后常见的问题。局限性肺不张通常耐受性良好且易于逆转。然而，部分肺切除术后剩余肺的完全肺不张可能耐受性较差。胸外科手术会增加风险，因为疼痛、胸肌损伤、胸壁不稳定和膈肌功能障碍会损害咳嗽时分泌物的清除。此外，肺部疾病患者容易出现支气管分泌物增加。预防措施包括术前和术后的物理治疗及药物治疗，应根据个体患者的风险因素进行分级。大面积肺不张需要支气管镜检查以清除黏液栓。对于复发性肺不张或吞咽障碍患者应考虑行气管切开术。
