1、手術(shù)前後呼吸衰竭Perioperative Respiratory Failure重癥課程2004.07.01.Key ManifestationsPulmonary edema (肺積水, 水分太多)Atelectasis (肺塌陷, 容量減少)Alveolar hypoventilation (換氣不足)Aspiration (異物吸入)Pulmonary EdemaMicrovascular hydrostatic pressure“normal” response trauma ADH, aldosterone conserve waterFluid overloadPulmonary

2、 capillary permeabilityUnrecognized sepsisLung EdemaAtelectasis (collapse)ConceptsFRCClosing volumePerioperative AtelectasisReduced FRCIncreased closing volume FRC falls with lying supine, obesity, pregnancy and anaesthesia, though not with age. The FRC is of particularly importance to anaesthetists

3、 because:During apnoea it is the reservoir to supply oxygen to the blood As it falls the distribution of ventilation within the lungs changes leading to mismatching with pulmonary blood flow If it falls below a certain volume (the closing capacity), airway closure occurs leading to shunt (see later

4、- Ventilation/perfusion/shunt)Lung CollapseRisk Factors of AtelectasisPromotingPreventingReduced FRCSupineUprightObesityAlternating posturesAscitesPEEPPeritonitisSighsUpper abdominal incisionAnalgesiaIncreased closing volumeAgePreop physiotherapySmokingCessationBronchospasmBronchodilationAirway secr

5、etionCough, suctionPulmonary edemaAvoid over hydrationAtelectasisDiaphragm dysfunctionUpper abdominal surgeryComplex effectsFall in vital capacity, decrease in FRC, increase in closing volumeA major component of perioperative respiratory failureDiaphragm DysfunctionAspirationGastric acid aspirationV

6、ariable presentationOne of the major causes of morbidity and mortalityThe Treatment of Acid Aspirationrapid removal of debris placement of a nasogastric tube oxygen administration and mechanical ventation bronchodilator therapy maintenance of normovolemia treatment of pnemoniaPredicting and PreventingRisk factors correctionLung function studyNo precise parametersSpecific respiratory dysfunction treatment modalities improve preoperative statusLung resectionTreatment PrinciplesPreoperative reha