Post-operative and post-traumatic pneumonia
Introduction
Introduction to post-operative and post-traumatic pneumonia Post-operative and post-traumatic pneumonia, also known as post-traumatic pneumonia in the clinic, lack of pulmonary ventilation, poor diaphragmatic activity, impaired or suppressed cough reflex, bronchospasm and dehydration, can cause bronchial secretions to stay, leading to lung segment Zhang, and then a lung infection. The incidence of such infections is higher after chest or abdominal surgery, and the incidence of pneumonia after inhalation anesthesia and spinal anesthesia is equal, and only 10% after local anesthesia or intravenous anesthesia. The common pathogen of empyema after thoracic surgery is Staphylococcus aureus, and about 40% of post-traumatic pneumonia is a complication of rib fracture or chest trauma. The incidence of pneumonia in skull fractures or other head injuries, other fractures, burns, or major contusions is equal. basic knowledge The proportion of illness: 0.21% Susceptible people: no specific population Mode of infection: non-infectious Complications: empyema
Cause
Post-operative and post-traumatic pneumonia causes
Due to insufficient lung ventilation after surgery and trauma, poor diaphragmatic activity, impaired or inhibited cough reflex, bronchospasm and dehydration can cause bronchial secretions to remain, leading to atelectasis, resulting in pulmonary infection, resulting in Inflammation.
Prevention
Post-operative and post-traumatic pneumonia prevention
Patients with smoking, acute and chronic respiratory infections, chronic bronchitis, emphysema, and asthma patients should quit smoking before surgery, perform chest physical therapy and target infection to control infection, relieve phlegm, relieve phlegm and supportive therapy. Comprehensive treatment, to achieve satisfactory pulmonary function and then surgery, usually after 1 to 2 weeks of preparation, can have significant effects, before and after treatment should be compared with pulmonary function tests, internal medicine comprehensive treatment should continue until the surgery and postoperative.
1. Quit smoking
According to statistics, the incidence of postoperative PPC in smoking patients is about 4-6 times that of non-smokers. Smoking increases small airway resistance and reduces lung immune function. Long-term large smokers are often accompanied by chronic bronchitis and emphysema. It has been reported that smoking cessation 6 to 8 weeks before surgery, the function of respiratory mucociliary mucus transport system is improved, PPC is significantly reduced; immediately before surgery, blood carboxyhemoglobin (half-life of about 6h) and P50 values are close to normal, and the patient's blood oxygen transport capacity is enhanced.
2, chest physical therapy
Before the spell, the patient can take a deep breath, cough and sputum, reduce airway resistance, reduce the chance of infection, and increase respiratory muscle strength. It is an effective method to prevent and treat PPC. The method is to inhale deeply to the total amount of lungs, and then cough after 3 to 4 seconds. 3 times will exhale, if necessary, supplemented by turning over the back, anti-infective, diastolic bronchial, phlegm and other treatments, after surgery, you can use the soft cotton pad to press the incision exercise to reduce pain, stimulating tidal meter ( IS) exercises can also improve respiratory muscle strength and endurance, increase FRC, and reduce complications such as atelectasis. IS is a daily tidal volume meter for patients to breathe. After deep inhalation, hold the breath for 2 to 3 seconds, and then deep Slowly exhaling the air, requiring a daily increase in tidal volume (VT), each time lasting 30 minutes, 6 times a day, this is one of the best recognized physical therapy, IS also requires patients to learn before surgery.
3, control infection
For those with respiratory infections, they can be treated empirically before surgery, and then adjusted according to the bacterial culture and drug sensitivity results.
4, relieve phlegm and asthma
When patients with chronic bronchitis, emphysema or asthma have bronchospasm, they are mainly inhaled with theophylline and bupropion and/or 2 agonist. Asthma patients should also use glucocorticoid inhalation. Inhalants have different methods of administration, including metered dose inhalers (MDI) and inhalers, dry powder inhalation and aqueous solution inhalation, as appropriate, sputum viscous, can also use bromine hydrochloride Ambroxol is administered orally or nebulized, intravenously.
5. Obesity among other elderly people (more than 30% of standard weight)
Quite common, obesity leads to decreased chest compliance, alveolar collapse, reduced ventilatory reserve and pulmonary ventilation dysfunction, postoperative PPC can be increased by a factor of two, elderly obese patients often have sleep apnea syndrome (SAS) and obesity - low Ventilation syndrome, for patients with SAS and obesity-hypopnea syndrome, nasal (or nose and mouth) mask continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), etc. should be given before and after surgery. And the necessary drugs (such as protriptyline) treatment.
Complication
Postoperative and posttraumatic pneumonia complications Complications
Complications are similar to other bacterial-induced pneumonia complications, but involve trauma or surgery in the lungs and mediastinum, followed by more pneumonia with empyema.
Symptom
Symptoms of post-operative and post-traumatic pneumonia Common symptoms Postoperative fever, snoring, cough, chest pain, fever, cough, sputum... Fever with chills, cough, dyspnea, purulent surgery, traumatic dryness, wet sounds
Like other pneumonia caused by the same bacteria, chest X-rays can show evidence of pulmonary infiltrates and/or atelectasis, sometimes with evidence of pulmonary embolism and infarction, the latter usually with bloody sputum, and purulent sputum often indicates infection. However, sometimes small amounts or mucus-like mites also contain a large number of pathogens, and bacteriological examinations of sputum and bronchial secretions show Gram-negative bacilli, Staphylococcus aureus, pneumococcus and Haemophilus influenzae or a mixture of these bacteria.
Examine
Post-operative and post-traumatic pneumonia examination
Post-operative and post-traumatic pneumonia, like other infectious pneumonia, is mainly performed on chest X-rays, bacteriological examination of sputum and bronchial secretions.
Diagnosis
Diagnosis and differentiation of postoperative and posttraumatic pneumonia
The disease needs to be differentiated from other types of pneumonia. The most prominent feature of this disease is history of trauma or surgery. It is not difficult to distinguish it from other pneumonia by medical history and laboratory examination.
