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1、·42·江西醫(yī)學院學報2004年第44卷第6期 ActaAcademiaeMedicinaeJiangxi2004,Vol44,No6纖維支氣管鏡在急危重病人氣道管理中的應用況九龍,段鳳英,齊協(xié)飛,顏春松,巫隆湖,范希光,饒瑋華(江西醫(yī)學院第二附屬醫(yī)院呼吸科,江西南昌330006)摘要:目的 探討纖支鏡在急危重病人氣道管理中的作用。方法 回顧性總結支氣管鏡對34例重癥病人進行氣道管理中的清理作用及治療咯血,肺炎及肺不張等臨床經(jīng)驗。結果 10例肺部感染患者,經(jīng)纖維支氣管鏡治療后感染均得到不同程度的控制,其中6例痊愈出院;7例肺不張者,4
2、例行纖支鏡1次肺復張,1例行纖支鏡2次后復張,余2例配合其它治療措施后復張;大咯血9例患者,經(jīng)纖支鏡局部應用腎上腺素及凝血酶,6例咯血立即停止,3例明顯減輕;機械通氣患者4例,2例痰栓致肺不張,其中1例左肺不張纖支鏡吸引沖洗后復張2例診斷氣管插管球囊滑脫/破裂,指導換管成功。困難氣管插管患者均因常規(guī)方法失敗后經(jīng)纖支鏡引導插管成功。結論 支氣管鏡是對急危重癥病人進行氣道管理的極有價值的工具,即可用于協(xié)助氣管插管,又可勝任氣道的清理作用及診治大咯血,難治性肺部感染及急性肺不張等。關鍵詞:纖支鏡;危重醫(yī)學;氣道管理中圖分類號:R562文獻標
3、識碼:A文章編號:1000-2294(2004)06-0042-03TheApplicationofFiberopticBronchoscopyinAirwayManagementofAcuteCriticalPatientsKUANGJiu2long,DUANGFeng2ying,QIXie2fei,YANChun2song,WULong2hu,FANXi2guang,RAOWei2hua(DepartmentofRespiratoryMedicineSecondAffiliatedHospitalofJiangxiMedicalC
4、ollege,Nanchang330006,China)ABSTRACT:ObjectiveToinvestigatetheeffectoffiberopticbronchoscopyontheairwaymanage2mentofacutecriticalpatients.MethodsOurrecentexperienceofapplicationoffiberopticbron2choscopytoclearingairwayinthemanagementofacutecriticalpatientsandtotreatingh
5、emoptysis,pneumoniaandatelectasisetc.wassummarized.ResultsTherewere10casesofpulmonaryinfectioninthestudy,allthemwerecontrolledwith6casescured.Of7casesofatelectasisinthestudy,4caseswererehabilitatedbyfiberopticbronchoscopyatonetimeand1casewasatsecondtime;whilere2mained2c
6、aseswererehabilitatedbyothertherapies.Therewere9casesofmassivehemoptysis,6caseswereceasedrapidlybylocalaffusingnoradrenalinandthrombinand3caseswerealleviatedobviously.Therewere4casesofmechanicalventilaioninthestudy.Among2casesofsputumembolusresultinginatelectasis,1caseo
7、flightatelectasiswasrehabilitatedbytakinglavement;theother2casesweresuccessfullytreatedbyreplacingprolapsus/brokentracheaintubationsacculus.Allpatientswithdiffi2culttracheaintubationinthestudywerewellmanagedbybeingintubatedaftertheroutinemethodsfailed.ConclusionFiberopt
8、icbronchoscopyisagreatvalueinstrumentintheairwaymanagementofacutecriticalpatients,whichmaybeappliedtoaidtrache
