便携式纤支镜引导经鼻气管插管在抢救COPD合并呼吸衰竭中的应用价值探讨(1)
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【摘要】目的:探讨床边便携式纤支镜(简称纤支镜)引导经鼻气管插管抢救COPD合并呼吸衰竭的临床应用价值。方法:COPD合并呼吸衰竭患者分别采用经口气管插管和便携式纤支镜引导经鼻气管插管并进行机械通气,总结分析其临床资料。结果:便携式纤支镜引导经鼻气管插管49例,成功48例,经口气管插管26例,成功22例。结论:便携式纤支镜引导经鼻气管插管迅速准确、携带方便、操作时间短,患者痛苦小易耐受,成功率高,并发症少,值得临床推广应用。
【关键词】便携式纤支镜;气管插管;COPD
doi:10.3969/j.issn.1006-1959.2010.08.057文章编号:1006-1959(2010)-08-2036-02
Application of endotracheal intubation through the nose under the guidance of portable fibrobronchoscope in patients with COPD combined respiratory failureCUI Li-hua,ZHABG Jian,HAO Xing-liang,LIN Jing-shuang,FENG Tao,WANG Shi-shou
【Abstract】Objective:To explore clinical value of endotracheal intubation through the nose under the guidance of portable fibrobronchoscope in patients with COPD combined respiratory failure.Methods:The patients with COPD combined respiratory failure received endotracheal intubation through the nose under the guidance of portable fibrobronchoscope and through the oral under direct vision,respectively.All patients received mechanical ventilation after endotracheal intubation.The clinical date was analyzed.Results:49 cases received endotracheal intubation through the nose under the guidance of portable fibrobronchoscope,48 cases were successful.26 cases received endotracheal intubation through oral under under direct vision,22 cases were successful.Conclusion:Endotracheal intubation through the nose under the guidance of portable fibrobronchoscope is swift,accurate,short time operation,high success rate,few combination.Patients were tolerated well.It is a worthy popularizing technique.
【Key words】Portable fibrobronchoscope;Endotracheal intubation;COPD
慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)是目前我国主要死亡原因之一,急性加重期合并呼吸衰竭是导致患者死亡的直接原因。气管插管是COPD合并呼吸衰竭的主要救治措施,为治疗引起或诱发呼吸功能不全的病变赢得时间。既往气管插管多采用喉镜明视下进行,常出现一些并发症。使用便携式纤支镜引导下经鼻气管插管,抢救呼吸衰竭其优越性逐步被认识。2008年1月至2010年3月,我科使用便携式纤支镜引导下经鼻气管插管49例,效果满意。同时抽取既往喉镜明视下经口气管插管病例26例进行两组病人在插管所需时间、气管插管留置时间、对生命体征影响、插管成功率、插管结束后并发症等方面进行比较,现总结如下:
1.资料与方法
1.1一般资料:两组共75例,便携式纤支镜引导下经鼻气管插管组(A组)49例,为2008年1月～2010年3月,因COPD急性加重期合并呼吸衰竭住院病人,经抗感染,解痉及无创机械通气治疗无效,男39例,女10例,年龄52～86岁。喉镜引导下经口气管插管组(B组)26例,为既往因COPD急性加重期合并呼吸衰竭住院病人,经抗感染,解痉及无创机械通气治疗无效,男17例,女9例,年龄46～79岁。
1.2治疗方法:便携式纤支镜引导下经鼻气管插管患者全部在心电监护及SaO2监测下行纤支镜引导气管插管:患者去枕平卧,检查鼻腔是否通畅,选择插管的一侧鼻腔,采用PENTAX公司的FB2 15BS便携式纤支镜 ......
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