纤维支气管镜在严重胸部创伤诊断及治疗中的价值

Role of fibrobronchoscopy in diagnosis and treatment of severe chest trauma

目的探讨纤维支气管镜（简称纤支镜）在严重胸部创伤的诊断及治疗中的价值。方法回顾性分析我院1999年1月-2007年7月应用纤支镜进行诊断及治疗的严重胸部创伤患者114例。总共应用纤支镜检查、灌洗治疗289次。纤支镜进入途径：经鼻腔181次，气管插管32次，口腔20次，气管切口套管56次。术前、术中、术后严密监护和监测SaO2及血气分析，同时给予吸氧或呼吸机支持。结果114例经纤支镜检查明确诊断，对102例患者进行了灌洗治疗。全部患者经1～4次纤支镜检查及灌洗后SaO2均明显提高（P〈0．01），术后2hPaO2改善明显（P〈0．05）。无因纤支镜检查治疗导致死亡的患者。结论纤支镜在严重胸部创伤中有重要的诊断及治疗价值，不但可及时明确支气管损伤的诊断，而且可以有效清除气道异物、分泌物、血及痰痂，治疗阻塞性肺不张及阻塞性肺炎，明显改善呼吸功能、提高救治成功率。

Objective To explore the role of fibrobronchoscopy in diagnosis and treatment of severe chest trauma. Methods A retrospective analysis was done on 114 patients with severe chest trauma who were diagnosed and treated by fibrobronchoscope from January 1999 to July 2007. We finished 289 times of fihrohronchoscopies including 181 times through nasal cavity, 32 through tracheal, 52 through oral cavity and 56 through tracheostomy tube. SaO2 and arterial blood gas were monitored continuously before and after operation, and respirator support or oxygen was administered simultaneously. Results Definite diagnosis was achieved in all patients, of whom were 102 patients treated with lavement. SaO2 was significantly increased in all patients after bronchial lavement （ P 〈 0. 01 ） and PaO2 was significantly ameliorated two hours after bronchial lavement （ P 〈 0. 05 ）. Conclusions Fibrobronchoscopy can identify diagnosis of bronchial injury and remove foreign body, secretion, blood and phlegm for patients with severe chest trauma. Meanwhile, fihrohronchoscopy can relieve obstructive atelectasis and obstructive pneumonia, improve respiratory function and hence increase survival rate.