全肺切除與惡化的慢性阻塞性肺疾病個案之呼吸照護經驗

Respiratory Care Experience of Pneumonectomy and Exacerbation of Chronic Obstructive Pulmonary Disease Cases

林惠釧(Hui-Chuan Li) ； 許重梅(Chung-Mei Hsu) ； 謝慧觀(Huei-Guan Shie)

《呼吸治療》 10卷2期 (2011/07) Pp. 43-56

https://doi.org/10.6269/JRT.2011.10.2.04

摘要

個案曾行左側全肺切除術合併有惡化的慢性阻塞性肺疾病之病患，術後存留肺，肺餘容積／肺總容量比值增加與COPD產生的流速限制，皆會造成空氣滯留與過度充氣情況。當個案疾病惡化，其換氣與灌流不平均之情況將更加嚴重。而單肺換氣合併慢性阻塞性肺疾病之個案，在居家照護時，可教導呼吸放鬆技巧與自發性引流配合用力吐氣技術來排除深部痰液。氣切患者可使用氣切發聲閥增加與家人互動，並練習吞嚥以減少肺部的吸入性感染。另外需考量個案居家環境與設備，設計簡易規律之肢體運動來增加肌肉耐力，以維持適當之心肺功能與呼吸道衛生，避免痰液累積。若疾病惡化於急性期，呼吸器設定可採用壓力控制通氣模式，提供保護性策略給予較低之潮氣容積與適當的吐氣末正壓，避免因機械通氣造成肺損傷。另外降低吸氣時間合併吐氣靈敏值使用，延長吐氣時間，以改善病患與呼吸器不同步之情況，並減少存留肺與慢性阻塞性肺疾病造成空氣滯留與過度充氣之狀況。而肺部復原運動在急性期與居家皆需持續進行，方可達到改善個案生活品質之最大目的。並以爲未來由重症與長期照護各階段呼吸治療，相互合作延續治療，以期給予個案完整的全程照護。

關鍵字

全肺切除術 ； 單肺通氣 ； 存留肺

並列摘要

This has been a case for the implementation of pneumonectomy and combined with the exacerbation of chronic obstructive pulmonary disease. RV/TLC ratio increases and flow limit by COPD will cause air trapping and over-inflated to the remaining lung. When the situation is getting worse, mismatch of ventilation and perfusion also becomes deleterious.It is thought in the home care of one-lung ventilation with chronic obstructive pulmonary disease cases, techniques of relaxation and autogenic drainage with forced expiratory techniques help to remove deep sputum. Tracheotomy patients can use speaking valve for interaction with their families, and swallow training to reduce aspiration pneumonia. On the other hand, cooperated with the home environment and equipment, design simple and repeated limb excise to increase muscle endurance, and proper function of heart and lung can help for respiratory health and to prevent mucus accumulation. If the disease is in acute progression, ventilator pressure control ventilation can be set to protect; lower tidal volume and positive end expiratory pressure can be applied to avoid lung injury caused by mechanical ventilation. Also reduce of inspiration time combine with use of expiratory trigger sensitivity, extend exhaled time to improve unsynchronized problem between ventilator and patients, and to reduce the retention of lung and chronic obstructive pulmonary disease caused by air trapping and hyperinflation.The pulmonary rehabilitation is required at home and in the acute phase to improve the quality of life. Also, cooperation between Severe and long-term care by the various stages of respiratory therapy treatment is going to provide complete care to the COPD cases.

並列關鍵字

pneumonectomy ； one lung ventilation OLV ； remaining lung