后肺并发症-英文.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Post-Pneumonectomy Complications,-A few,short,notes,Alan D L,Sihoe,Complications,Remember:,General,complications,Vs,Operation-specific,complications,Also:,Early vs Late complications,Post-pneumonectomy complications,30-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 adjuvant therapy,+,Respiratory failure,$,Sepsis,$,Male sex,$,*,Eur J Cardiothorac Surg 2001;20:476-80,+,J Thorac Cardiovasc Surg 2001;121:1076-82,$,Am Surg 2001;67:318-21,Respiratory failure:50-100%mortality,Prevention most important,e.g.pre-op chest physio,optimise COAD Mx etc.,Smoking,(,Ann Thorac Surg 2001;72:1662-7),Only factor associated with Major Pulmonary Event,With MPE:mortality rate increased almost 20 x,1.Respiratory complications,Cardiac dysrhythmias:40%,Esp.,Atrial,fibrillation,Can you think why?,Myocardial infarction,often similar risk factors(e.g.age,smoking),2.Cardiac complications,3.Bronchopleural fistula,3-6%of lung resections,Esp.post-,pneumonectomy,lobectomy,Factors:,Ann,Thorac,Surg,2001;72:1662-7,Technique(long stump),Medical co-morbidities(COAD&poor FEV1,DM),Adjuvant therapies(steroid),Ventilation/,BiPAP,also:Infection,Tumour,3.Bronchopleural fistula,Presentation:,SOB,Cough,fluid from post-pneumonectomy space,Bubbling from chest drain,(if one present),Decreased fluid level on CXR,Confirm diagnosis by bronchoscopy,4.Post-pneumonectomy syndrome,Herniation,of heart,mediastinal contents towards pneumonectomy space,k,inking/distortion 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,5.Post-pneumonectomy infection,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,