手術後併發急性肺損傷的胃癌病患呼吸照護問題探討

當胃癌細胞已蔓延至十二指腸及胰臟頭部時，手術切除是常見的處置方式，但上腹部手術易影響橫膈肌功能而導致手術後呼吸系統的併發症，尤其是接受胰及十二指腸切除如Whipple手術，術後常易發生全身性發炎反應症候群（systemic inflammatory response syndrome, SIRS）及急性肺損傷（acute lung injury, ALI）併發呼吸衰竭，故其呼吸照護十分重要。本病例在Whipple手術後產生急性肺損傷，導致混合型呼吸衰竭。追蹤其血清中胰澱粉酶指數在術後急速升高，疑似術後因感染產生急性胰臟炎而導致敗血症、病況加劇惡化後形成肺水腫與急性呼吸衰竭。其呼吸治療處置上除了呼吸道通暢的維持外，選擇適當的氧氣治療器材以提供病人足夠的氧合及針對敗血症合併急性肺損傷之呼吸器設定等均是重要的治療策略，以減少併發症的產生。經適當處置後，本病例已在呼吸衰竭後五天內成功的拔除人工氣道及移除呼吸器，本文將分享其呼吸照護經驗。

關鍵字

急性胰臟炎；敗血症；急性肺損傷；手術後呼吸照護

並列摘要

Surgical intervention is the common choice of treatment when the gastric cancer cells have spread to the duodenum and pancreatic head. Patients that had received upper abdominal surgery (e.g. Whipple operation) are more likely to have their diaphragm function affected and to develop postoperative pulmonary complications. These patients are likely to develop systemic inflammatory response syndrome (SIRS) and acute lung injury (ALI) complicated with acute respiratory failure easier. Therefore, postoperative respiratory care is critical for these patients.This patient developed an acute lung injury and mixed type respiratory failure post-Whipple operation. The serum concentration of pancreatic amylase increased rapidly postoperatively and was diagnosed as a postoperative infection caused by acute pancreatitis for this patient. This resulted in sepsis, acute pulmonary edema, and then acute lung injury.　The respiratory care strategies that the patient had received included maintaining airway patent, applying the appropriate ventilator settings and adjustments, and oxygen support to provide adequate respiratory function and prevent pulmonary complications. The patient was successfully weaned from mechanical ventilation and extubated within 5 days after appropriate management. We will share our care experience with readers.

並列關鍵字

Acute pancreatitis ； Sepsis ； Acute lung injury (ALI) ； Postoperative respiratory care

國際替代計量

手術後併發急性肺損傷的胃癌病患呼吸照護問題探討

全文下載

主題瀏覽