- 期刊
肺氣腫病人行肺容積減除手術之呼吸照護經驗
Experience of Respiratory Care for a Emphysema Patient Undergoing Lung Volume Reduction Surgery
摘要
慢性阻塞性肺病（chronic obstruction pulmonary disease; COPD）是由慢性發炎導致呼吸道阻塞之疾病，其中肺氣腫（emphysema）為其中一種型態。肺氣腫為遠端氣道彈性減弱且合併肺泡壁破壞，造成肺容積永久增大的疾病，由於通氣灌流不配合，病人常會感到呼吸困難，造成生活上不便以及痛苦，除了藥物治療外，在其他非藥物治療部分若符合某些特定條件，手術將會是個可以參考的選擇。本個案為GOLD（The Global Initiative for Chronic Obstructive Lung Disease; GOLD）grade D級COPD且長期使用非侵襲性呼吸器（non-invasive positive pressure ventilation; NIPPV）的病人，肺部影像上呈現局部而非廣泛的肺氣腫，故採取肺容積減除手術（lung volume reduction surgery; LVRS），於術後發生嚴重漏氣之併發症，故後續再將破掉的大泡（bullae）切除並維持胸管引流以及化學性肋膜沾黏術（chemical pleurodesis），術後調整呼吸器的設定為PCV mode、低潮氣容積、低吸氣時間、較低的PEEP及高濃度氧氣間歇使用，而拔管後的深呼吸訓練以及肺復原運動也成為病人手術復原成效良好的重要因素之一。藉此LVRS手術後成功脫離呼吸器且出院之COPD個案，提供各位呼吸治療師了解此手術所需要注意的事項、術後呼吸器調整及復原計畫之策略。
並列摘要
Chronic obstructive pulmonary disease (COPD) is a disease that is characterized by persistent airflow limitation due to chronic inflammation. Emphysema is one of the phenotypes of COPD. Emphysema is characterized by hyperinflation and decreased elasticity of the airways resulting from structural degradation and inflammation of lung tissue. COPD patients with emphysema commonly have dyspnea that caused poor life quality due to V/Q mismatch. In addition to medical treatment, surgery is an alternative option for a subgroup of emphysema patients. We presented a patient of GOLD (Global Initiative for Chronic Obstructive Lung Disease) COPD group D, who is non-invasive ventilator dependent. He underwent lung volume reduction surgery (LVRS) because of local and heterogeneous emphysema. Severe air leakage occurred after the LVRS. He received segmentectomy of the air leaking bullae and chemical pleurodesis. The strategy of the ventilator setting included PCV mode, low tidal volume, low inspiratory time, low PEEP, and intermittent high-concentration oxygen. Lung expansion maneuvers and pulmonary rehabilitation also contributed to good postoperative recovery after extubation. We hope to provide important information of ventilator adjustment strategy and postoperative respiratory care for emphysema patients undergoing LVRS.