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頁籤選單縮合
題 名 | 食道癌術後氣管漏氣病人之呼吸照護經驗=Respiratory Care for Tracheal Leakage in Esophageal Cancer Patient Post Esophagectomy |
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作 者 | 張玉雅; 馮瑞芳; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 12:2 2013.07[民102.07] |
頁 次 | 頁81-93 |
分類號 | 415.415 |
關鍵詞 | 氣道壓力; 食道癌術後; 氣管漏氣; Airway pressure; Post-esophagectomy; Tracheal leakage; |
語 文 | 中文(Chinese) |
中文摘要 | 食道癌術後患者的合併症包含出血、膿瘍、感染、瘻管及傷口吻合處滲漏等。其中又以後天氣管或支氣管瘻管的發生率為最低,但一旦發生卻是極為嚴重的合併症。主要是因為其不當的氣體交換、吸入性肺炎、縱膈炎、敗血症…等原因導致呼吸衰竭或死亡。故此類病人之呼吸照護亦是一重要課題。本病患接受食道切除手術後,疑似術後傷口吻合處滲漏發炎及支氣管局部缺血壞死產生瘻管導致呼吸衰竭,經由支氣管鏡檢查發現有支氣管肋膜瘻管與食道後縱膈腔瘻管。又因吸入性肺炎導致病況惡化加劇造成急性呼吸窘迫症候群(acute respiratory distress syndrome, ARDS)。醫療處置上除藥物控制與置放支架外,呼吸治療處置則以維持病人基本足夠氧合、適當的潮氣容積及避免過高的氣道壓力的通氣方式,來減少病患氣管漏氣之併發症及肺損傷的惡化。本病患最後依然因多重器官衰竭死亡,但因本院對此類病人之呼吸照護經驗仍顯不足,希望能以本文的經驗分享與探討,以期增進此類病人呼吸照護的品質。 |
英文摘要 | The complications after esophagectomy for esophageal cancer include bleeding, abscess, fistula, and leakage of the anastomosis. Post-esophagectomy tracheobronchial fistula is a rare but catastrophic complication. They frequently result in respiratoy failure and death due to inadequate gas exchange, aspiration pneumonia, mediastinis, or sepsis. Therefore, it is an important issue to care such patients. The patient after esophagectomy developed respiratory distress, and bronchoscopic study identified a bronchopleural fistula and a mediastinal-esophageal fistula. They were considered to be caused either by inflammation from leakage of the anastomosis, or from ischemia after extensive peribronchial dissection. The condition deteriorated rapidly due to aspiration pneumonia, and it resulted in acute respiratory distress syndrome. Our treatment strategies include medication control, esophageal stents placement. Ventilator strategies include maintenance of adequate oxygenation, low airway pressure, and appropriate tidal volume during mechanical ventilation to reduce complications of tracheal leakage and lung injury. This patient expired due to multiple organs failure. However, our experience in such patients is limited, so we will share and discuss our care experience with readers. |
本系統中英文摘要資訊取自各篇刊載內容。