- 期刊
雙腔氣管內管合併獨立肺通氣應用於胸腔外傷個案之呼吸照護經驗
The Experience of Respiratory Care for a Pulmonary Hemorrhage Case Provided with Double-Lumen Endotracheal Tube and Independent-Lung Ventilation
摘要
雙腔氣管內管(double-lumenendotracheal tube,DLT)合併獨立肺通氣(independent-lung ventilation,ILV) 一般常見用於外科手術，其中又以胸腔外科手術過程使用最為廣泛，有避免交叉感染其他肺區與肺保護隔離上。本個案因車禍導致右側胸腔重創(氣、血胸)至開刀房執行「posterolateral thoracotomy and lobectomy + multiple rib fracture correction + bronchoscopy」，術後以DLT 人工氣道轉入加護病房。照護過程期間，因雙肺順應性差異極大，導致通氣/灌流比(ventilation/perfusion ratio,V/Q) 不平衡加劇，後期出現氣道阻塞等合併症。即便呼吸器介入ILV通氣模式欲降低肺損傷與進一步的惡化導致成人呼吸窘迫症候群(acute respiratory distress syndrome ,ARDS)發生，但血氧濃度仍極度不穩 (SpO_2＜70%、PaO_2/FiO_2 radio＜100)、血中二氧化碳分壓直竄攀升 (PaCO_2:47~57 mmHg)。最終是採用葉克膜體外氧合系統 (extracorporeal membrane oxygenation, ECMO) 輔助，才得已緩解嚴重低血氧情形。但此個案在使用ILV 期間之雙腔氣管內管照護及通氣運用，是呼吸治療師照護重點，希望能以本文的分享與探討，以期增進此類呼吸照護品質。
並列摘要
Double-lumen endotracheal tube (DLT) combined with independent lung ventilation (ILV) has been used to avoid cross-infection to the other lung area. It is commonly applied in the thoracic surgery. One patient who had a right lung pneumothorax and hemothorax due to a traffic accident was operated with posterolateral thoracotomy and lobectomy plus a multiple rib fracture correction. After the operation, he was given DLT and taken care in the intensive care unit (ICU). During the hospitalization, the compliance of two lungs was extremely different which resulted in a ventilation/perfusion ratio (V/Q) imbalance and airway compression at late phase. ILV was applied to decrease the deterioration of lung injury and acute respiratory distress syndrome (ARDS). Even ILV was applied, the oxygen saturation and PaO2/FiO2 of the patient were still extremely unstable, and increase of PaCO_2 level. The severe hypoxemia was resolved eventually after the intervention ofextracorporeal membrane oxygenation (ECMO). The care used DLT and ILV ventilation mode during the acute period. We anticipate the galling of respiratory care could improve through the exploration and discussion of this case.
延伸閱讀
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