纤维支气管镜在严重多发伤并发呼吸衰竭救治中的应用

Bronchofibroscopy in treatment of severe multiple injury respiratory failure

目的探讨纤维支气管镜技术在严重多发伤患者并发呼吸衰竭急救中的作用。方法对33例急诊创伤(肺挫伤,多发肋骨骨折伴肺塌陷或连枷胸,血胸接受闭合胸腔引流,严重颅脑外伤,颈椎外伤伴高位截瘫,气管外伤,多发股骨和肋骨骨折等)并发呼吸衰竭的患者应用纤维支气管镜技术引导经鼻气管插管、气道管理等。结果对12例患者在纤支镜引导下进行经鼻插管,进行呼吸机辅助通气;5例经口插管10天内改经鼻插管。对22例肺部感染或合并叶、段肺不张、肺实变患者进行纤支镜下吸痰,其中对15例严重脑外伤、严重肺挫伤伴多发肋骨骨折、颈椎外伤高位截瘫等并发肺不张患者行支气管肺泡灌洗,术后患者血氧饱和度及氧分压明显升高;对15例患者复查胸部CT或床旁胸片,肺均基本复张。26例患者好转出院,住院时间在18～180天。7例死亡或家属放弃治疗。结论纤支镜能及时经鼻气管插管而保证气道通畅,清除气道分泌物及异物,支气管肺泡灌洗治疗肺部感染及肺不张,在严重多发伤并呼吸衰竭的急救中有重要作用。

Objective To investigate the role of bronchofibroscopy in treatment of severe multiple injury respiratory failure.Methods Thirty-three patients of severe multiple injury combined with respiratory failure,21 males and 12 females,aged 37.7±14.5,with the underlying diseases of severe pulmonary contusion,multiple rib fracture with lung collapse or flail chest,hematopneumothorax undergoing closed thoracic drainage,severe cranial injury,injury of cervical vertebrae with high-level paraplegia,tracheal injury,multiple fracture of femur and ribs,etc.,underwent nasotracheal intubation or airway management guided by bronchofibroscopy.Results Twenty-two of the 32 patients underwent nasotracheal intubation guided by bronchofibroscopy and respirator-aided ventilation.Five patients were treated with insertion through the mouth first,and then nasotracheal intubation was performed 10 days later.Sputum aspiration was conducted through the bronchofibroscope on 22 patients of lung infection with lobar or segmental atelectasis or lung consolidation.Bronchoalveolar lavage was conducted on 15 patients with severe brain injury,lung contusion combined with multiple rib fracture,high-level paraplegia caused by injury of cervical vertebrae with atelectasis.The levels of oxygen saturation and oxygen partial pressure significantly increased after the procedure.Chest CT or bedside roentgenography in 15 cases showed lung reexpansion.Twenty-six patients were discharged after the improvement of their conditions with a hospital stay of 18~180 days.Seven patients died or were discharged because of withdrawal of treatment by their families.Conclusion Bronchofibroscopy helps conduct nasotracheal intubation,keep the airway unobstructed,clear the secretion or foreign bodies in the airway,or perform bronchoalveolar lavage,thus playing an important role in treatment of severe multiple injury respiratory failure.