アブストラクト
| Title | 術後肺合併症を予防する呼吸管理 |
|---|---|
| Subtitle | 特集「手術侵襲と臓器不全」 |
| Authors | 大藤純 |
| Authors (kana) | |
| Organization | 徳島大学大学院医歯薬学研究部救急集中治療医学講座 |
| Journal | 外科と代謝・栄養 |
| Volume | 55 |
| Number | 1 |
| Page | 29-33 |
| Year/Month | 2021 / 2 |
| Article | 報告 |
| Publisher | 日本外科代謝栄養学会 |
| Abstract | 術後肺合併症(postoperative pulmonary complication, PPC)の頻度は高く, 周術期死亡や重症呼吸不全の主原因となる. PPCは, 無気肺, 肺炎, 肺水腫, 慢性肺疾患の急性増悪など多様な病態を含む. PPC高リスク症例における呼吸管理では, 術中の肺保護換気に加えて, 術後の経鼻高流量酸素療法(high flow nasal cannula, HFNC), 非侵襲的陽圧換気(noninvasive positive pressure ventilation, NPPV)などの呼吸補助療法を一連で行うことが重要である. 肺保護換気では, 術式や体格, 慢性肺疾患の有無, 術前からの肺傷害の程度などを評価したうえで, 適切な一回換気量とPEEPを設定し, 必要に応じて肺リクルートメント手技を組み合わせ, 人工呼吸器関連肺傷害の予防に努める. 術後の呼吸補助療法として, HFNCは忍容性が高く, I型呼吸不全に広く用いられる. 一方, NPPVは肺リクルートメント効果に優れ, PPC高リスク患者の挿管回避に有効であるが, 忍容性は低く長期使用には向かない. HFNCおよびNPPVの特性を理解した使い分けと再挿管の時機を逸しない厳重な管理が必要である. |
| Practice | 臨床医学：外科系 |
| Keywords | 術後肺合併症, 肺保護換気, 人工呼吸器関連肺傷害 |
- 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。
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