The lung does not open after surgery. Breathing, therapeutic exercises and exercise therapy after lung surgery. Cramps your legs at night

Pulmonary diseases are very diverse, and doctors use different methods their treatment. In some cases, therapeutic measures are ineffective, and in order to overcome dangerous disease, it is necessary to use surgical intervention.

Lung operations are a forced measure that is used in difficult situations when there is no other way to cope with the pathology. But many patients experience anxiety when they find out they need such surgery. Therefore, it is important to know what such an intervention is, whether it is dangerous, and how it will affect a person’s future life.

It should be said that chest surgery using latest technologies do not pose any threat to health. But this is only true if the doctor performing the procedure has a sufficient level of qualifications, and also if all precautions are followed. In this case, even after serious surgical intervention the patient will be able to recover and live a full life.

Indications and types of operations

Lung operations are not performed unless absolutely necessary. The doctor first makes attempts to cope with the problem without using radical measures. However, there are situations when surgery is necessary. This:

In any of these cases, it is difficult to cope with the disease using only medications and therapeutic procedures. However, at the initial stage of the disease, these methods can be effective, which is why it is so important to seek help from a specialist in a timely manner. This will avoid the use of radical treatment measures. So, even if these difficulties are present, surgery may not be prescribed. The doctor must take into account the characteristics of the patient, the severity of the disease and many other factors before making such a decision.

Operations performed for lung diseases are divided into 2 groups. This:

Lung transplant surgery, which appeared relatively recently, is discussed separately. It is carried out in the most difficult situations, when the patient’s lungs stop functioning, and without such intervention his death will occur.

Life after surgery

It is difficult to say how long it will take the body to recover after surgery. This is influenced by many circumstances. It is especially important that the patient follows the doctor’s recommendations and avoids harmful effects, this will help minimize the consequences.

If there is only one lung left

Most often, patients are concerned with the question of whether it is possible to live with one lung. It is necessary to understand that doctors do not make the decision to remove half an organ unless necessary. Usually the patient’s life depends on this, so this measure is justified.

Modern technologies for various interventions allow one to obtain good results. A person who has undergone surgery to remove one lung can successfully adapt to new conditions. This depends on how correctly the pneumectomy was performed, as well as on the aggressiveness of the disease.

In some cases, the disease that caused the need for such measures returns, which becomes very dangerous. However, this is safer than trying to save the damaged area, from which the pathology can spread even further.

Another important aspect is that after a lung is removed, a person should visit a specialist for routine checkups.

This makes it possible to detect a relapse in a timely manner and begin treatment to prevent similar problems.

In half of the cases, after a pneumoectomy, people become disabled. This is done so that a person can avoid overexerting himself while performing his work duties. But receiving a disability group does not mean that it will be permanent.

After some time, disability can be canceled if the patient’s body has recovered. This means that living with one lung is possible. Of course, precautions will be required, but even in this case, a person has a chance to live a long time.

It is difficult to talk about the life expectancy of a patient who has undergone lung surgery. It depends on many circumstances, such as the form of the disease, timeliness of treatment, individual endurance of the body, compliance with preventive measures, etc. Sometimes a former patient is able to lead a normal life, limiting himself to virtually nothing.

Postoperative recovery

After any type of lung surgery has been performed, the patient’s respiratory function will be impaired for the first time, so recovery implies the return of this function to normal. This happens under the supervision of doctors, so primary rehabilitation after lung surgery involves the patient staying in the hospital. D

In order for breathing to normalize faster, special procedures, breathing exercises, and medicines and other measures. The doctor selects all these measures individually, taking into account the characteristics of each specific case.

A very important part of recovery measures is the patient’s nutrition. You should check with your doctor about what you can eat after surgery. Food shouldn't be heavy. But to restore strength, you need to eat healthy and nutritious food, which contains a lot of protein and vitamins. This will strengthen the human body and speed up the healing process.

In addition, what is important at the recovery stage proper nutrition, other rules must be followed. This:

It is very important not to miss preventive examinations and tell your doctor about any adverse changes in your body.

Question: “I had an operation: they removed 2 segments of the right lung. Histology results: in the lung tissue there are large foci of caseous necrosis of varying degrees of age, some with calcium inclusions, with a capsule along the periphery, etc. The operation was successful, the lung opened, and the stitches were healed. But my arms hurt a lot, I lift them with great difficulty and pain, my abdominal muscles don’t work at all. Will all this be restored and what needs to be done for this? And how long should you take the pills if you took them for 4 months before the operation and for 3 months after the operation?”, asks Nadezhda.

A doctor of the highest category, pulmonologist, Alexander Nikolaevich Sosnovsky, answers:

Caseous necrosis can be a consequence of two absolutely various pathologies lung – tuberculosis and fungal infection. Therefore, in preoperative and rehabilitation period Completely different medications may be taken. If the infection is fungal, then the course of treatment continues based on the presence of other foci of mycotic dissemination. In the postoperative period it can be up to 12 months.

However, it is more common pulmonary tuberculosis. The standard duration of daily use of anti-TB drugs after surgery is 4 months. Then, for 4 years, anti-relapse courses are required for 3 months annually. According to the decision of the phthisiopulmonologist, medication use after surgery can be extended to six, and sometimes up to 12 months. This depends on the individual characteristics of the development of tuberculosis in a particular patient. Decisive general state the patient, the presence of changes in tests, the study of acute phase parameters and the results of the postoperative Diaskin test. The usual practice is to carry out after 6 months computed tomography lungs in order to exclude new foci of screening. If the tests are normal and your health is satisfactory, then anti-TB drugs are not used for more than 4 months.

Arm pain and abdominal weakness are unlikely to be related to surgery. Typically, the postoperative period proceeds with general weakness, which disappears approximately 14 days after the intervention. There are many reasons why these symptoms may develop. Firstly, many anti-tuberculosis drugs are quite difficult to tolerate human body. The main thing is them side effect– influence on the peripheral nervous system. As a result, the nerves that are responsible for the normal functioning of the limbs and abdominal muscles can be damaged. Canceling specific anti-tuberculosis drugs will lead to complete restoration of muscle function, weakness and pain will completely disappear. In your case, you probably have no more than 1 month left to take them.

Secondly, weakness and muscle pain are often caused by changes in the electrolyte composition of the blood. The operation could provoke an imbalance, and it is often difficult to restore it without accurately determining the deficiency or excess of a specific electrolyte. It is enough to conduct an extended biochemical blood test in any clinic at your place of residence. This will greatly clarify the situation. A referral for an analysis, which is performed free of charge if you have an insurance policy, can be obtained from your local physician.

Thirdly, the symptoms you mentioned may be caused by other diseases that worsened after surgery. It could be chronic infection, which causes intoxication, as well as degenerative-dystrophic diseases of the spine. To exclude these ailments, it is best to also contact a primary care specialist. He will give a referral for an x-ray of the spine, ultrasound abdominal cavity, Ultrasound of the heart and various additional tests. If any changes are detected, the doctor will help coordinate treatment himself or offer consultation with specialists.

So, your anti-tuberculosis drugs will soon be stopped. If all discomfort After this, they will pass, then they were probably associated with long-term use of medications. In any case, taking additional tests and talking with your local therapist will not be a bad idea in the near future.

An operation to remove the lung or part of it affected by the disease is prescribed in cases where their functioning becomes unsatisfactory. In this case, the healthy active areas take over the breathing function. If the affected part is not removed, decay products and toxins will poison the body and provoke complications in the form of infections. In addition, the disease can spread to healthy tissue.

Immediately after surgery, shortness of breath appears, and ventilation of the lungs and oxygen supply to the body deteriorates. Phenomena such as rapid heartbeat, headaches and dizziness may occur. There is no need to be afraid of this. Such phenomena are a natural reaction of the body to the surgery, a speedy recovery after which is facilitated by a number of measures, which we will discuss in this article.

It is necessary to completely stop smoking. Smoking is destructive for anyone, but especially for people who have had lung surgery. Smoke irritates the mucous membrane, causing profuse secretion of sputum, which is extremely undesirable in the postoperative period. Due to excess phlegm, a situation may arise where part of the lung is not completely filled with air, which can lead to pneumonia. If the patient cannot quit smoking on his own by force of will, due to excessive dependence, it is recommended to seek help from a psychotherapist.

In addition to smoking, other factors also have an irritating effect: gas or dust in the air, the presence of toxic and highly toxic substances in the air. active ingredients. Such places should be avoided, and a humidifier or air ionizer should be installed at home.

Drinking large portions of alcohol depresses respiratory function and weakens the body. Maximum dose alcohol for postoperative patients is 30 g ethyl alcohol for men and 10 g for women. For people with low weight, the dosage also does not exceed 10 g. For people who have renal failure, alcoholic heart damage, nervous system or the liver needs to completely stop drinking alcohol.

Nutrition after surgery

For a speedy recovery, the body must receive complete and easy-to-digest nutrition. Dishes must contain sufficient amounts of vitamins, nutrients and fiber. Fresh fruits, juices, vegetables are mandatory in the diet. various types. At the same time, salt consumption should be limited as much as possible. Daily norm table salt does not exceed 6 g.

If before the operation the patient was obese or overweight, then after the operation it is vitally important to bring the body weight back to normal. This is extremely important because excess weight significantly loads the cardiac and respiratory systems, increases shortness of breath.

Physical activity in the postoperative period

To avoid inflammation of the lungs caused by stagnation in them, to improve the functioning of the intestines and train the muscles involved in breathing, they are prescribed literally from the first hours after recovery from anesthesia. physical exercise. Against the background of drug treatment, all patients, without restrictions on age and gender, can continue physical training.

Performing exercises in the first hours after surgery prevents the formation of blood clots and congestion, activates the body's reserves, forcing those parts of the lung to work that may have been inactive before the operation, and stimulates a speedy return to active life. Early activity involves frequent changes of positions in bed. This gives the muscles work and helps to “open” the lungs. Side and stomach positions can make breathing easier, but back positions with the head of the bed elevated should be avoided.

When the body gets used to it, you can start training, but with a caveat: active exercises are contraindicated for people with shortness of breath at rest, with impaired vision, hearing or motor functions. An acute infectious disease may also be a contraindication.

Relaxation

The most important component of a set of physical exercises is relaxation. Begin relaxation with the legs, then the muscles of the arms and chest, then the neck. You can perform it in a standing or sitting position. When performing any physical exercise, the patient needs to remember that if one or another muscle group is not currently involved, then it needs to be relaxed. Every lesson therapeutic exercises should end with a general relaxation of all muscles in a lying position.

Pain, anesthesia and low mobility make breathing shallow, which provokes stagnation in the respiratory tract. If there are no contraindications, then long-term and regular physical exercises are prescribed, as well as breathing training using a PEP bottle simulator or similar devices. A PEP bottle, roughly speaking, is a plastic container filled with water with a small cross-section tube inserted into it. The patient's task is to inhale air through the nose and exhale through the mouth using a straw in a bottle. Positive result noticeable after just a few days of training. However, patients must continue physical activity and work with breathing simulators throughout their lives.

After several months of regular training to strengthen muscles, exercises with weights may be recommended.

The reason for stopping training may be:

Obvious fatigue.
Shortness of breath is worse than usual.
Muscle spasms.
Sharp deviations from normal blood pressure.
Excessive heartbeat.
The appearance of chest pain.
Dizziness, noises, beating, headache.

Drug treatment

In the postoperative period, the main task of the doctor and the patient is to prevent the accumulation of sputum in the lungs. Therefore, prescribed by a doctor drug treatment, mainly aimed at facilitating coughing. For this purpose, herbal teas, syrups and drugs that have an expectorant effect are used. For bronchitis with impaired patency in the bronchi, medications are prescribed to dilate the bronchi.

The treatment of vascular and cardiac diseases requires special attention, since they significantly affect the general condition of the body, worsen well-being, preventing the patient from full physical training. Almost all patients are prescribed drugs that facilitate the functioning of the cardiac system under new conditions. However, any course of treatment should be prescribed and supervised exclusively by the attending physician.

Planned or emergency lung surgery is performed for serious pathologies of this the most important body breathing when conservative treatment impossible or ineffective. Like any surgical intervention, manipulation is carried out only in cases of necessity, when the patient’s condition requires it.

The lungs are one of the main organs respiratory system. They are a reservoir of elastic tissue that contains respiratory vesicles (alveoli) that facilitate the absorption of oxygen and the removal of carbon dioxide from the body. The pulmonary rhythm and the work of this organ as a whole are regulated by the respiratory centers in the brain and the chemoreceptors of the blood vessels.

Surgery is often required for the following diseases:

pneumonia and other severe inflammatory processes;
tumors of a benign (cysts, hemangiomas, etc.) and malignant (lung cancer) nature;
diseases caused by the activity of pathogenic microorganisms (tuberculosis, echinococcosis);
lung transplant (for cystic fibrosis, COPD, etc.);
hemothorax;
pneumothorax (accumulation of air in the pleural region of the lungs) in some forms;
Availability foreign bodies due to injury or injury;
adhesions in the respiratory organs;
pulmonary infarction;
other diseases.

However, lung surgery is most often performed for cancer, benign cysts, and tuberculosis. Depending on the extent of the affected area of the organ, several types of such manipulation are possible.

Depending on the anatomical features and the complexity of the ongoing pathological processes, doctors can decide on the type of surgical intervention.

Thus, a distinction is made between pneumonectomy, lobectomy and segmentectomy of an organ fragment.

Pulmonectomy - removal of the lung. Represents the view abdominal surgery By complete removal one part of a paired organ. A lobectomy is considered to be the removal of a lobe of the lung that is affected by infection or cancer. Segmentectomy is performed to eliminate a segment of the lobe of one lung and, along with lobectomy, is one of the most common types of surgery on this organ.

Pulmonectomy, or pneumonectomy, is performed in exceptional cases for extensive cancer, tuberculosis and purulent lesions or large tumor formations. The operation to remove a lung is performed under general anesthesia exclusively by the cavity route. In order to remove such a large organ, surgeons open the chest and in some cases even remove one or more ribs.

Typically, lung excision is performed using an anterolateral or lateral incision. When removing a lung for cancer or in other cases, it is extremely important to leave the root of the organ, which includes the vessels and bronchi. It is necessary to maintain the length of the resulting stump. If the branch is too long, there is a possibility of developing inflammatory and purulent processes. After removing the lung, the wound is stitched tightly with silk, and a special drainage is inserted into the cavity.

Lobectomy involves excision of one or more (usually 2) lobes of one or both lungs. This type of operation is one of the most common. It is performed under general anesthesia using the abdominal method, as well as the latest minimally invasive methods (for example, thoracoscopy). In the cavity version of the surgical intervention, the availability of access depends on the location of the lobe or fragment being removed.

Thus, a lung tumor of a benign or malignant nature, located in the lower lobe, is excised using a posterolateral approach. Elimination of the upper and middle lobes or segments is performed by an anterolateral incision and opening of the chest. Removal of a lobe of the lung or part of it is performed in patients with cysts, tuberculosis and chronic abscess of the organ.

Segmentectomy (removal of part of the lung) is performed if a tumor of a limited nature is suspected, with small localized tuberculosis foci, small cysts and lesions of an organ segment. The excised area is separated from the root to the peripheral area after blocking and ligating all arteries, veins and bronchus. Afterwards, the segment to be removed is removed from the cavity, the tissue is sutured, and 1 or 2 drains are installed.

The period before surgery should be accompanied by intensive preparation for it. So, if the general condition of the body allows, aerobic exercise and breathing exercises will be useful. Often such procedures make it possible to ease the period after surgery and speed up the evacuation of purulent or other contents from the pulmonary cavity.

Smokers should quit bad habit or minimize the number of cigarettes consumed per day. By the way, it is this malicious habit that is the main cause of lung diseases, including 90% of cases of cancer of this organ.

The preparatory period is excluded only in case of emergency intervention, since any delay in the operation can threaten the patient’s life and lead to complications and even death.

From a medical point of view, preparation for surgery consists of examining the body and identifying the location pathological process in the operated area.

Among the studies required before surgery are:

general urine and blood tests;
blood test for biochemistry and coagulogram;
X-rays of light;
ultrasonography.

In addition, with infectious and inflammatory processes Before surgical procedures, therapy with antibiotics and anti-tuberculosis drugs is prescribed.

Rehabilitation period

Lung operations of any complexity are a traumatic process that requires a certain period of recovery. In many ways, the successful course of the period after surgery depends both on the physical state of health of the patient and the severity of his illness, as well as on the qualifications and quality of the specialist’s work.

In the postoperative period, there is always a risk of developing complications in the form of infectious and inflammatory processes, respiratory dysfunction, failure of sutures, the formation of non-healing fistulas, etc.

To minimize the negative consequences after surgery, treatment with painkillers and antibiotics is prescribed. Oxygen therapy and a special diet are used. After some time, a course of therapeutic exercises and breathing exercises (physical therapy) is recommended to restore the functions of the respiratory system and speed up the recovery process.

During abdominal surgery on the lung (pneumectomy, etc.), the patient’s ability to work is fully restored in about a year. Moreover, in more than half of the cases, disability is registered. Often, when one or more lobes are removed, external defects of the chest may be visible in the form of hollowness on the side of the removed organ.

Life expectancy depends on the characteristics of the disease and the person’s lifestyle after surgery. Patients with benign tumors after relatively simple interventions for resection of organ fragments have the same life expectancy as ordinary people. Complications after severe forms of sepsis, gangrene and lung cancer, relapses and an unhealthy lifestyle simply have a negative impact on the overall life expectancy after surgery.

Kruglov Sergey Vladimirovich

Kruglov Sergey Vladimirovich, Professor,Doctor of Medical Sciences, Honored Doctor of the Russian Federation, surgeon of the highest qualification category,

Page editor:

Semenisty Maxim Nikolaevich

Leading specialists in the field of thoracic surgery.

Polozyukov Illarion Alexandrovich

Polozyukov Illarion Alexandrovich, Head of the Department of Thoracic Surgery of the Regional Specialized Tuberculosis Hospital, Thoracic Surgeon of the Highest Qualification Category

Diagnosis and surgery of pulmonary suppuration. P.P.Kovalenko, A.T.Anisimova

Patients undergoing surgery need proper management of the postoperative period, which largely determines the outcome of the operation.

Despite the improvement of surgical techniques and anesthesiology, lung operations continue to be a rather difficult intervention and are accompanied by life disorders. important functions body. Complications are also common, and mortality rates range from 2% (103) to 7.1% (11).

In this regard, the doctor must take into account the peculiarities of the operation, the disturbances that arise in the respiratory system, blood circulation and metabolic processes in the patient’s body.

The main task of the postoperative period in patients with pulmonary suppuration is the normalization of the respiratory and cardiovascular systems, as well as the prevention and treatment of postoperative complications.

Management of the early postoperative period in our clinic is carried out by the attending physician together with the anesthesiologist who performed the anesthesia. Such continuity ensures timely recognition and treatment of emerging complications.

After surgery, patients are placed in specially designated intensive care wards in the clinic. These wards usually contain the equipment necessary for emergency assistance. There is an installation for continuous supply of humidified oxygen, a set of instruments for tracheostomy, intra-arterial blood injection, bronchoscopy and artificial respiration devices. In addition, there is the necessary diagnostic equipment: an electrocardiograph, an encephalograph, a spirograph, an X-ray machine, etc. These wards are staffed by well-trained medical staff.

The clinic has adopted the following method of managing the patient after surgery.

From the operating room on a functional bed the patient is delivered to the intensive care ward with a system for intravenous administration of blood, solutions and other medications. In the first hours after surgery, the patient lies in a horizontal position. A few hours after the operation, with good hemodynamic parameters, the patient is given a semi-sitting position, which improves breathing and activity of cardio-vascular system. The patient inhales humidified oxygen through a nasal catheter, which is necessary to reduce and eliminate hypoxemia. Oxygen inhalations continue for several hours, and in subsequent days, if necessary.

In the first 4-5 days after surgery, all patients are prescribed 3 ml of 20% camphor every 6-42 hours and 1-2 ml of cordiamine 2 times a day. In addition, a 40% glucose solution with 1 ml is administered intravenously. 0.5% vitamin Bi solution and 1-3 ml b% solution ascorbic acid. Next, the patient is prescribed 1-2 ml of a 1-2% solution of promedol or pantopon, which is administered after 4-6 hours for 3-4 days. Drugs calm patients down, they develop deep breathing, less painful cough and sleep comes. We widely use oxygen inhalation with aerosols of 2% soda solution and the addition of other drugs (chloramphenicol, ephedrine, thyme and enzymes) in patients after lung surgery. These inhalations improve the general condition of patients, promote the removal of sputum and the cough becomes effective.

The clinic uses two management methods pleural cavity after lung resection: closed and drainage with active aspiration. After the patient is put to bed, the drainage is connected to a water-jet suction, and antibiotics are administered daily through the drainage tube. 24-48 hours after lung resection, the drains are removed and further sanitation of the pleural cavity is carried out by puncture.

Necessary treatment after surgery is antibacterial therapy antibiotics, which are administered intramuscularly, intravenously and in the form of aerosols, taking into account the data of bacteriological studies.

From the second day after surgery, breathing exercises are performed and movement in bed is allowed. With a smooth postoperative course, the patient can get out of bed and walk from the 2nd day after surgery.

In the vast majority of our patients, the operations proceeded smoothly, but in the early postoperative period the following complications were observed: acute blood loss, shock, bronchospasm, pulmonary edema, thromboembolism and pulmonary heart failure.

Respiratory failure in the majority of operated patients was observed in the first 48-72 hours, was expressed to varying degrees and was compensated by a constant supply of humidified oxygen. In cases of severe respiratory failure in patients, tracheostomy was used with inhalation of oxygen through a catheter inserted into the tracheotomy tube. Over the course of several years, we have become convinced positive action tracheostomy for both prevention and treatment of respiratory failure (85). IN Lately For the same purpose, percutaneous catheterization of the trachea is used.

Atelectasis of the remaining part of the lung is a serious complication and can develop 1-3 days after surgery. For minor atelectasis clinical symptoms weakly expressed.

With extensive atelectasis, a severe picture of respiratory failure develops. We perform early subnacotic bronchoscopy with suction of sputum and blood clots, lavage of the bronchi with a solution of furatsilin, followed by straightening of the lung or part of it.

To eliminate bronchospasm, drug therapy is used: atropine, ephedrine, intravenous adrenaline 1 ml 1:1000, 10 ml 1% novocaine, 10 ml 10% calcium chloride, etc. are administered. If there is no effect, it is necessary to urgently open the chest cavity and perform direct lung massage (79).

Pneumonia in the postoperative period develops more often on days 4-5 after surgery. Antibiotics are prescribed to treat postoperative pneumonia wide range actions, sulfonamides, expectorants, sedatives and cordials. We combine oxygen therapy with inhalation of antibiotic aerosols.

Thus, for the prevention of postoperative pulmonary complications should be improved bronchial patency, using a set of measures: gentle surgical technique and bronchial intubation, sanitation of the tracheobronchial tree before and during surgery, lung expansion, compo-

/leke exercises physical therapy, inhalation of humidified oxygen and alkaline aerosols, and when indicated, we resort to bronchoscopy and tracheostomy.

Cardiovascular disorders after lung surgery are observed in the majority of patients, the severity of which can be expressed to varying degrees. Often this condition is relieved in the immediate hours after surgery by administering camphor, cordiamine, glucose with vitamins, and oxygen inhalation.

At severe forms cardiovascular failure, a 0.05% solution of strophanthin (0.25-0.5) with a 40°/o solution of glucose and a B complex of vitamins should be administered intravenously! C, ATP, cocarboxylase, and also use cordiamin, korglykon, etc. Against the background of hormonal treatment (hydrocartisone, prednisolone, etc.), intensive transfusion therapy is indicated using blood transfusions, blood replacement fluids, as well as solutions that are persistently retained in bloodstream (polyglucin, polyvinyl-pyrrolidone, protein, albumin, etc.).

In case of cardiac arrest, a complex is performed resuscitation measures, including cardiac massage (closed and open method), artificial ventilation of the lungs using various methods (mouth to mouth, anesthesia machine mask, through an endotracheal tube) and drug therapy, consisting of injection into the cavity of the left ventricle 1 ml of 0.1% atropine solution, 0.5-1 ml of adrenaline solution and 0 ml of 10% calcium chloride solution.

Pulmonary edema, as a complication after surgery, in last years is rare. When large quantity dry and moist wheezing in the lungs or one remaining lung is used intravenous administration strophanthin (0.25 - 0.5 ml) with 40% glucose solution, 10% calcium chloride solution and dehydration agents. The administration of novourite (0.5-4 ml), mannitol (20% - 250 ml), lyophilized urea (urogluca), as well as bronchodilators (aminophylline, diaphylline, atropine, pipolfen, etc.) has a good effect. If pulmonary edema increases, intubation with artificial respiration of oxygen with alcohol, suction of sputum through a catheter, or tracheostomy is necessary. Cervical vagosympathetic blockade and application of tourniquets help reduce pulmonary edema. lower limbs(hips). In severe cases of pulmonary edema, it is possible to use bloodletting in an amount of 300-400 ml.

Recently, when dressing the lung, so-called bloodless bloodletting has been used, carrying out controlled hypotension with the help of ganglion-blocking drugs - arfonade, etc. Arfonad is administered by intravenous drip, after 2-3 minutes arterial pressure can be reduced to 80-70 mmHg. Art. This treatment method acute edema lungs is highly effective.

Bleeding into the pleural cavity after lung resection is a serious complication. In our practical work, we observed bleeding, often significant, arising from the vessels of pleural adhesions.

Reimbursement of blood loss with hemostatic therapy helps prevent severe consequences.

Massive bleeding is accompanied by symptoms of collapse. In these cases, immediate rethoracotomy is performed with ligation of the bleeding vessel and simultaneous blood transfusion in large doses with full compensation of blood loss. The introduction of epsilon-aminocaproic acid, calcium chloride, glucose, cocarboxylase (100-200 mP) also has a good therapeutic effect. However, even immediate rethoracotomy does not always save the patient.

Experience in treating patients with pulmonary suppuration and their complications after surgical interventions has allowed us to develop a number of measures that must be performed in the preoperative period, during and after surgery.

During the period of preoperative preparation, prevention of complications consists of long-term sanitation purulent focus in the lungs, the fight against purulent intoxication and general strengthening treatment.

During the operation, it is necessary to treat tissues with care. The elements of the lung root should be treated separately. The bronchial tube is isolated together with the peribronchial tissue. The bronchus is cut off high, sutured with a UKB apparatus and, if possible, pleurization of the bronchus stump is performed or plastic surgery is performed with frozen allogeneic tissues if local tissues are not enough. During the operation, it is necessary to achieve good expansion of the remaining part of the lung, removal of air and blood from the pleural cavity, and sputum from the bronchi.

In the postoperative period, patients should also undergo a set of measures aimed at preventing the development of purulent pleurisy. After removing the entire lung, if there is a large accumulation of exudate in the pleural cavity, it is removed by puncture in an amount of no more than 300-400 ml.

The next day after the operation, the patient undergoes an X-ray or fluoroscopy of the chest to monitor the condition of the lung.

After removing the drainage tube, the pleural punctures with removal of effusion and administration of antibiotics. In the postoperative period, inhalation with chloramphenicol and other medications is carried out, as well as breathing exercises. At 3-5 years of age, blood is transfused in the amount of 200-250 ml.

With a smooth course of the postoperative period, patients are discharged in good condition after partial resection of the lung on days 15-20 and on days 25-28 after removal of the entire lung.

Thus, the prevention of complications after lung surgery for suppuration is based on a set of measures in the preoperative period, during surgery and in the postoperative period.

Accumulated experience surgical treatment chronic suppuration of the lungs allowed a number of researchers to understand the complex changes in the patient’s body after surgery.

Therefore, in recent years, much attention has been paid to the rehabilitation of patients, i.e., restoration of body functions after surgical interventions on the lungs.

The most important indicators of the effectiveness of surgical treatment of patients with pulmonary suppuration are long-term results, the timing of the development of compensatory processes and restoration of working capacity.

According to most authors (50, 91, 92, 107), good long-term results range from 62.9 to 91%. Recently, a number of researchers (38, 60, 97) have found that in the long-term period after surgery, changes are detected in the resected lung, which cause a lower percentage of good and excellent results.

We studied long-term results over a period of 1 to 10 years in 170 people who underwent operations of varying volumes. Most patients were examined in an inpatient setting, a small group was examined on an outpatient basis.

The general condition of the majority of the examined patients was quite satisfactory. The most common complaints patients made were varying degrees shortness of breath and palpitations physical activity, fatigue and intermittent pain in the area of the postoperative scar.

During an external examination of patients in the long term after pneumonectomy, the chest on the side of the intervention appears to be reduced in volume. The heart and other mediastinal organs in almost all patients are significantly displaced to the operated side. The volume of the healthy half of the chest is increased due to the expansion of the intercostal spaces. Often the boundaries of the remaining lung increase significantly and extend to the operated half of the chest.

After removal of one or two lobes of the lung, the deformation of the chest is mild or completely absent.

The timing of obliteration of the pleural cavity in uncomplicated cases after removal of the entire lung ranges from 6-8 months, and after removal of part of the lung, the residual cavity is eliminated within up to 4 months.

The X-ray picture is different. After pneumonectomy (Fig. 23), an increase in the volume of the remaining lung is determined, which fills the anterior mediastinum - an anterior mediastinal hernia is formed. On the operated side, total darkening is determined due to fibrothorax or the presence of a horizontal fluid level with the dome of the diaphragm being pulled up and the mediastinal organs moving to the operated side. After resection of part of the lung (Fig. 20, 24), X-ray examination showed almost no pathological changes. In persons who have undergone postoperative complications, there was a significant displacement of the mediastinal organs, stomach, intestines, and sometimes blood vessels and heart.

Depending on the data obtained, patients were divided into groups with good, satisfactory and poor results (Table 7).

Good outcomes were assessed in those examined people who had no complaints, were able to work and were practically healthy. With satisfactory results, improvement was noted after surgery, but a cough remained with the release of purulent sputum in a small amount. Bad results- The operation did not improve my health.

Examination of patients at various times after surgery revealed certain compensatory possibilities in normalizing function external respiration and cardiovascular

After marginal resection, after 9-11 months, the respiratory parameters of the operated lung are completely normalized and a state of compensation occurs. After lobectomy (Fig. 24), after 1-2 years there is a partial restoration of the main respiratory parameters of the operated lung.

The compensatory tension of the other lung decreases, but remains in a state of moderate hyperfunction. The process of compensatory restructuring ends by the first year and most patients return to their previous work. 1-1.5 years after bilobectomy, the indicators of external respiration of the expanded lung increase, but reach only 40-50% of the proper value. During these periods, there is a gradual increase in external respiration indicators and staoilization of the body in new conditions.

After pneumonectomy, significant changes occur in the respiratory function of the remaining lung (Fig. 23). 1 year after this operation, the vital capacity in the remaining lung reaches preoperative figures, and oxygen absorption and minute respiratory volume exceed them by 50% or more (when calculating indicators for one lung). The body’s adaptation to new conditions ends 1 year after the intervention.

Almost all patients a year after pneumonectomy have a significant displacement of the heart towards the operation. On the ECG, some patients show rhythm disturbances, sinus tachycardia, deviation of the electrical axis to the right, which indicates hypertrophy of the right ventricle of the heart. After partial resections easy change on the part of the cardiovascular system are slightly expressed.

Thus, an analysis of the outcomes of surgical treatment of chronic pulmonary suppuration showed that long-term results definitely depend on the volume of surgical intervention and on postoperative complications.

In assessing the long-term results of patients who underwent radical operations on the lungs, restoration of working capacity is important (38, 73, 112).

Normalization of the functions of the respiratory, cardiovascular and other systems allowed the majority of patients to return to work. Of the 170 patients examined, in the long term after the operation, the ability to work was restored in 144 (84.7%), and of the 26 non-working patients, most of them do not work in production, but are engaged in housework, performing work of varying severity.

Among our patients, 19 people (69%) returned to work after pneumonectomy, 45 (86%) after bilobectomy, 70 (94%) after lobectomy, and 10 (100%) after marginal lung resection.

The study of long-term results of treatment allows us to conclude that surgical interventions performed in patients with chronic suppuration of the lungs provide a high percentage of recovery (71%) and improvement in well-being (18.6%), and also restore working capacity in 84.7%.

Our observations show that patients who have undergone radical operations on the lungs require clinical observation. It is necessary to examine patients within 6 months and 1 year after surgery, with subsequent observation for 1.5-2 years, that is, until stable compensation of impaired body functions is achieved.