纤维支气管镜在急危重病人气道管理中的应用VIP免费

收稿日期:2004-09-10作者简介:况九龙(1957-),男,硕士,教授,主任医师,研究方向:呼吸系统疾病的治疗。纤维支气管镜在急危重病人气道管理中的应用况九龙,段凤英,齐协飞,颜春松,巫隆湖,范希光,饶玮华(江西医学院第二附属医院呼吸科,江西南昌330006)摘要:目的探讨纤支镜在急危重病人气道管理中的作用。方法回顾性总结支气管镜对34例重症病人进行气道管理中的清理作用及治疗咯血,肺炎及肺不张等临床经验。结果10例肺部感染患者,经纤维支气管镜治疗后感染均得到不同程度的控制,其中6例痊愈出院;7例肺不张者,4例行纤支镜1次肺复张,1例行纤支镜2次后复张,余2例配合其它治疗措施后复张;大咯血9例患者,经纤支镜局部应用肾上腺素及凝血酶,6例咯血立即停止,3例明显减轻;机械通气患者4例,2例痰栓致肺不张,其中1例左肺不张纤支镜吸引冲洗后复张2例诊断气管插管球囊滑脱/破裂,指导换管成功。困难气管插管患者均因常规方法失败后经纤支镜引导插管成功。结论支气管镜是对急危重症病人进行气道管理的极有价值的工具,即可用于协助气管插管,又可胜任气道的清理作用及诊治大咯血,难治性肺部感染及急性肺不张等。关键词:纤支镜;危重医学;气道管理中图分类号:R562文献标识码:A文章编号:1000-2294(2004)06-0042-03TheApplicationofFiberopticBronchoscopyinAirwayManagementofAcuteCriticalPatientsKUANGJiu2long,DUANGFeng2ying,QIXie2fei,YANChun2song,WULong2hu,FANXi2guang,RAOWei2hua(DepartmentofRespiratoryMedicineSecondAffiliatedHospitalofJiangxiMedicalCollege,Nanchang330006,China)ABSTRACT:ObjectiveToinvestigatetheeffectoffiberopticbronchoscopyontheairwaymanage2mentofacutecriticalpatients.MethodsOurrecentexperienceofapplicationoffiberopticbron2choscopytoclearingairwayinthemanagementofacutecriticalpatientsandtotreatinghemoptysis,pneumoniaandatelectasisetc.wassummarized.ResultsTherewere10casesofpulmonaryinfectioninthestudy,allthemwerecontrolledwith6casescured.Of7casesofatelectasisinthestudy,4caseswererehabilitatedbyfiberopticbronchoscopyatonetimeand1casewasatsecondtime;whilere2mained2caseswererehabilitatedbyothertherapies.Therewere9casesofmassivehemoptysis,6caseswereceasedrapidlybylocalaffusingnoradrenalinandthrombinand3caseswerealleviatedobviously.Therewere4casesofmechanicalventilaioninthestudy.Among2casesofsputumembolusresultinginatelectasis,1caseoflightatelectasiswasrehabilitatedbytakinglavement;theother2casesweresuccessfullytreatedbyreplacingprolapsus/brokentracheaintubationsacculus.Allpatientswithdiffi2culttracheaintubationinthestudywerewellmanagedbybeingintubatedaftertheroutinemethodsfailed.ConclusionFiberopticbronchoscopyisagreatvalueinstrumentintheairwaymanagementofacutecriticalpatients,whichmaybeappliedtoaidtracheaintubationandbeequaltoclearingairway;itmayalsobehelpfulindiagnosisandtreatmentofmassivehemoptysis,difficult2to2controlpneumonia,andacuteatelectasisetc.KEYWORDS:fiberopticbronchoscopy;criticalcaremedicine;airwaymanagement纤维支气管镜(纤支镜)已广泛用于呼吸病的诊治,在危重病人中气道管理也日益受到重视,在急危·24·江西医学院学报2004年第44卷第6期ActaAcademiaeMedicinaeJiangxi2004,Vol44,No6©1995-2005TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.重病人的抢救中发挥了重要的作用。我院1990～2003年应用纤支镜对急危重病人进行气道的管理,在一定程度上对危重病人抢救,解决关键问题起到重要的作用。现将34例总结报告如下。1资料与方法1.1一般资料34例病人中男性26例,女性l4例。年龄18～68岁,平均年龄44岁。34例病人,临床上均属病重病危患者。重症肺部感染10例,其中慢阻肺肺部感染3例,支扩伴肺部重症感染3例肺脓疡2例,重症肺炎2例;急性肺不张7例,其中胸部手术后并发2例,上腹部手术后并发2例,出血血块阻塞所致3例;大咯血9例,其中...