后肺并发症-英文ppt课件

1、 Remember: General complications Vs Operation-specific complications Also: Early vs Late complications30-day post-op mortality 6-8% (Right Left)Risk factors for mortality:Advanced age*Bronchopleural fistula*Cardiovascular disease+ Hematologic disease+Right pneumonectomy+Extended resection+Pre-op adj

2、uvant therapy+ Respiratory failure$Sepsis$Male sex$* Eur J Cardiothorac Surg 2019; 20: 476-80+ J Thorac Cardiovasc Surg 2019; 121: 1076-82$ Am Surg 2019; 67: 318-21Respiratory failure: 50-100% mortalityPrevention most importante.g. pre-op chest physio, optimise COAD Mx etc.Smoking(Ann Thorac Surg 20

3、19; 72: 1662-7)Only factor associated with Major Pulmonary EventWith MPE: mortality rate increased almost 20 x Remember: only one functional lung lefti pulmonary reserve to cope with infection etc. Post-op care: Aggressive chest physio Early mobilisation Adequate analgesia Bronchial toileting if nec

4、essary Consider mini-tracheostomyCardiac dysrhythmias: 40% Esp. Atrial fibrillationCan you think why ?Myocardial infarctionoften similar risk factors (e.g. age, smoking)3-6% of lung resectionsEsp. post-pneumonectomy lobectomyFactors: Ann Thorac Surg 2019; 72: 1662-7 Technique (long stump) Medical co

5、-morbidities (COAD & poor FEV1, DM)Adjuvant therapies (steroid)Ventilation/BiPAPalso: Infection, Tumour Presentation: SOB Cough fluid from post-pneumonectomy space Bubbling from chest drain (if one present) Decreased fluid level on CXR Confirm diagnosis by bronchoscopy Management: Resuscitation

6、& oxygen Lie with pneumonectomy side DOWN Insert chest drain (if one not in situ already) Broad-spectrum antibiotic cover Consider double-lumen tubeConsider why we do each of these ! Low threshold for Surgical Repair Herniation of heart, mediastinal contents towards pneumonectomy space kinking/d

7、istortion of vascular structures cardiovascular collapse May require surgical correction ?fixing during initial op if problem anticipated Note: hence controversy over whether to leave chest drain in situ after pneumonectomy High mortality ?also develop other complications during prolonged treatment (e.g. infection) Difficult to eradicate warm, moist space antibiotics cannot reach Meticulous aseptic technique required during surgery Consider antibiotic lavage Management options: Drainage &