纤维支气管镜引导经鼻气管插管救治老年急性呼吸衰竭

The fiber bronchoscope as an aid to endotracheal intubation for emergency treatment of senile acute respiratory failure/

目的：探讨纤维支气管镜（纤支镜）引导经鼻气管插管对老年急性呼吸衰竭（呼衰）抢救的应用价值。方法：对３５例老年急性呼衰患者用纤支镜引导经鼻气管插管６３例次。患者取平卧位，选择较通畅的一侧鼻腔，先用１％地卡因行鼻腔及咽部粘膜喷雾麻醉３次，再用１％麻黄素液鼻腔粘膜喷雾以收缩鼻腔粘膜血管，减少或防止局部出血。纤支镜及导管内均涂以无菌硅油或液体石腊，将无菌气管导管套于纤支镜外。按纤支镜常规操作方法，由鼻腔插入气管，助手将气管导管沿纤支镜插入气管内，然后退出纤支镜。结果：纤支镜引导经鼻气管插管６３例次均获得成功。插管过程一般为２０秒～２分钟。结论：纤支镜引导经鼻气管插管抢救老年急性呼衰患者既安全，又迅速，值得推广。

bjective:To investigate the role of fiber bronchoscope as an aid to endotracheal intubation for emergency treatment of senile acute respiratory failure.Methods:35 senile patients with acute respiratory failure were intubated by the fiber bronchoscope as an aid.The patients were in horizontal position,nasal cavity of unobstructed side was chosen for aerosol anesthesia.Following three times aerosol anesthesia for nasal cavity and pharyngolaryngeal mucous membrane with 1% dicaine,1% ephedrine was given in aerosol to contract vessels of nasal cavity mucous membrane,thereby decreasing and preventing local bleeding.Sterile silicon oil or liquid paraffin was sprayed on the fiber bronchoscope and in catheter.Inserted the fiber bronchoscope into sterile catheter.Via nasal cavity,the catheter was inserted into the trachea by an assistant guided by the fiber bronchoscope,which was then withdrawn.Results:The fiber bronchoscope as an aid to endotracheal intubation was successfully used in 35 patients.The operation time needed only 20 seconds to two minutes.Conclusions:These data suggest that the fiber bronchoscope as an aid to endotracheal intubtion is safe and quick in emergency treatment of senile acute respiratory failure.