Postoperative pulmonary edema. Embolisms of the pulmonary artery after surgery
Novice Thoracic Surgeons It is often mistaken for a pulmonary edema of sputumwith difficulty of coughing it up in the first days after the operation. If, at a resection of the lung, bronchiectasis is only partially removed, which is especially often observed with bilateral lesions, the patient continues to separate the sputum, and can not cough it out due to weakness of the cough push and pain sensations.
As a result, sputum accumulates in the large bronchi and trachea and givesa picture of bubbling breath. It is audible at a distance, and when auscultation it manifests itself in the form of large bubbling moist wheezing more along the middle line of the chest. To release the airways from the pus, you need to create a drainage position: raise the pelvis, and the upper half of the patient's torso and head to the bed so that the angle of the torso to the horizontal reaches 45-60 °.
Do not pay attention to groan the patient, you need to force it vigorouslycleared throat in this position and after a few large spitting sputums go away, breathing immediately becomes free and all the phenomena of "pulmonary edema" disappear. It is even better to suck sputum through a bronchoscope.
Unfortunately, this complication can not end up so harmlessly, ifThe remaining lung has a large active purulent focus. In early 1950, one of our patients literally choked with sputum, excreted from the bronchiectasises of the second lung, which we did not give proper value before the operation.
This case served us a good lesson for the future with regard to strict verification of the "healthy" lung and the need for preoperative preparation for the elimination of bronchitis.
Embolisms of the pulmonary artery in recent years are increasinglystatistics of foreign surgeons as one of the causes of death after resection of the lungs. They gradually come to one of the first places, since other fatal complications are less and less common.
Pathogenesis of thromboembolism has not been sufficiently clarified. According to BK Osipov, GF Nikolaev, and our own observations, pulmonary embolism is more common in the elderly, after particularly complex and prolonged operations, and in patients with low functional parameters of the cardiovascular and respiratory systems.
In the domestic literature only isolated cases of pulmonary embolism are describedarteries after operations on the lungs. BK Osipov died one patient from this complication. GF Nikolaev points to the case of thromboembolism after a severe pneumonectomy operation, which also ended in the death of the patient. In the AV Vishnevsky Institute (AI Smaylis) there were eight patients with pulmonary embolism after lung operations, six of them died.
However, only one patient died from chronic suppurative disease, and seven - in operations for lung cancer.
In most cases pulmonary embolism develop suddenly, among relative well-being. Less often they complicate cardiopulmonary insufficiency. Terms of development - the first week after the operation.