纤维支气管镜在危重创伤监护中的应用

Application of fibrobronchoscopy in intensive care of patients with severe trauma

目的 探讨纤维支气管镜 (简称纤支镜 )在危重创伤监护中的应用 ,以及对严重创伤后肺、支气管并发症的治疗效果。方法 对本院 1999年 1月～ 2 0 0 3年 1月收治的 12 7例严重创伤引起支气管、肺部并发症应用纤支镜检查、灌洗治疗 4 2 8例次。纤支镜进入途径 :经鼻腔 5 7例次 ,口腔 2 2例次 ,气管切口套管349例次。术前、术中、术后严密监测SpO2 及血气分析 ,同时给予氧气或呼吸机支持。结果 全部病例经 1～4次纤支镜灌洗后SpO2 均明显提高 (P <0 .0 0 1) ,术后 2小时PaO2 改善明显 (P <0 .0 5 )。其中 4 3例肺不张经灌洗治疗后复张 39例。 2例明确为支气管不全断裂 ,经支气管修补术治愈。无 1例因纤支镜治疗直接导致死亡。结论 纤支镜在危重创伤伴发肺部并发症患者监护中应用 ,不但可及时明确诊断 ,而且可以有效清除气道分泌物及血、痰痂。明显改善呼吸功能、提高患者对严重创伤的承受力。

Objective To explore the therapeutic effect of fibrobronchoscopy in complication of bronchi and lungs in patients with severe trauma.Methods Inspection and bronchial lavement were performed by fibrobronchoscope to treat complication of lungs and bronchi in critical trauma for 428 person-time from Jan 1999 to Jan 2003.Fibrobronchoscope was introduced through nasal cavity for 57 person-time,through oral cavity for 22 person-time,and tracheostomy tube for 349 person-time.SpO 2 and arterial blood-gas were monitored continuously during operation,and respirator support or oxygen was administered simultaneously.Results SpO 2 was significantly higher after bronchus lavement(P<0.001),and SaO 2 was significantly higher at two hours after bronchial lavement.Conclusion Fibrobronchoscope can remove secretion,blood and phlegm and improve respiratory function and enduring capability during the inspection and treatment of complication of bronchi and lungs in critical trauma.