纤维支气管镜在呼吸衰竭患者机械通气治疗中应用价值探讨

Application of fiberoptic bronchoscope in patients with respiratory failure treated by Invasive mechanical ventilation

目的探讨纤维支气管镜(纤支镜)在呼吸衰竭患者有创机械通气治疗中的应用价值。方法回顾性分析189例行机械通气治疗的呼吸衰竭患者病历资料,包括气管插管,机械通气过程中纤支镜检查、取痰培养、吸痰、支气管冲洗、支气管肺泡灌洗、止血治疗、气管插管深度调整等。结果189例行纤支镜引导下经鼻气管插管,成功率100%;215例次经纤支镜吸痰、支气管冲洗或支气管肺泡灌洗;209例次纤支镜取痰细菌和真菌培养,阳性率为81.3%;6例经纤支镜止血治疗出血停止,有效率100%;24例经纤支镜直视下调整气管插管深度;6例检出支气管肿物。结论纤维支气管镜在呼吸衰竭患者机械通气治疗中具有很大的应用价值,值得推广。

Objective To evaluate the role of fiberoptie bronehoseope in patients with respiratory failure who were treated by invasive mechanical ventilation. Methods Retrospective analysis was performed on 189 cases with respiratory failure treated by invasive mechanical ventilation for nasal endotracheal intubation, endotracheal and endobronchial investigation, sputum aspiration,bronchial lavage（BL）, bronchoalveolar lavage（BAL）, treatment of hemoptysis and adjustment of intubation using fiberoptic bronchoscope. Results All of the cases had nasal endotracheal intubation using fiberoptic bronchoscope, successful rate was 100% ; 215times of sputum aspiration, bronchial lavage or bronchoalveolar lavage were performed; 209 times of sputum culture were performed through fiberoptic bronchoscope with 81.3% positive rate; Hemoptysis stopped after local treatment of hemoptysis using fiberoptic bronchoscope in 6 cases. Effective rate was 100% 24 cases with adjustment of intubation using fiberoptic bronchoscope;Bronchial neoplasms were investigated in 6 cases. Conclusion Fiberoptic bronchoscope in patients with respiratory failure treated by invasive mechanical ventilation is valuable and worth generalizing.