经纤维支气管镜引导气管插管在机械通气病人中的临床应用

Clinical Application of Endotracheal lntubation Under Guidance of Fibrebronchoscopy in Ventilation

目的探讨采用经纤支镜引导气管插管的方法、安全性、临床效果、并发症。方法对60例具有气管插管机械通气指征的患者采用经纤支镜引导气管插管，其中经鼻插管者45例，经口插管者15例，经口插管改换为经鼻插管者10例；分别测定术前、术后4h动脉血气分析及动态监测术前、术中、术后4h SaO2、HR；记录正式插管或换管操作时间。结果该操作技术简单易行；插管术后4 hPaO2（85±2．78）mmHg及SaO2（95±1．61）％与术前PAO2（56±2．65）mmHg及SaO2（87±2．59）％比较有上升、有显著性差异（P〈0．001）；插管术中SaO2（83±2．61）％与术前SaO2（87±2．59）％比较有下降，有显著性差异（P〈0．001），但平均插管操作时间（1．65±0．42）min短，病人能耐受；插管术中HR（123±5．23）次／min与术前HR（118±5．43）次／分比较有上升，有显著性差异（P〈0．001）；插管术后4hHR（90±4．70）次／min与术前HR（118±5．43次／分）比较有下降，有显著性差异（P〈0．001）；换管术中SaO2（95．7±0．95）％与术前SaO2（96．5±1．58％）比较有下降，但无显著性差异（P〉0．05），但平均换管操作时间（1．58±0．29）min短，病人能耐受；换管术中HR（93．7±5．76）次／min与术前HR（9013±5．42）次／min比较有上升，但无显著性差异（P〉0．05）；气管插管或换管操作术中均无心律失常发生，成功率100％（60／60）。结论采用经纤支镜引导气管插管或换管的方法具有操作技术易掌握、简单易行、行之有效、操作时间短、病人痛苦小能耐受、安全性好、插管准确、成功率高、并发症少等优点，值得临床推广应用。

Abjective To explore the method ofendotracheal intubation under guidance fibrebronchoscopy, and its safety, clinical effects and complication possibility.Methods 60 patients with signs of mechanical ventilation were intubated Under Guidance of Fibrebronchoscopy, 45 cases through nose, 15 cases through mouth and 10 cases changed intubation approach from mouth to nose respectively. The following data were tested,recorded and analyzed, including Blood Gas analysis of before and 4 hours after intubation, SaO2 and HR（heart rate） of before,during and 4 hours after intubation. The time of intubation or changing intubation has been recorded. Results The method is easy to operate. After 4 hours of intubation, PaOE（85±2.78）mmHg and SAO2（95±1.61）% increased and were much different（P〈 0.001）,compared with that before intubation,During intubation SAO2（83±2.61）% decreased and were much different（P〈 0.001）, compared with that SaO2 （87 ±2.59）% before intubation.But the average operation time of intubation（1.65±0.42）min was short and the patients can be surffered.During intubation the HR（123±5.23）min increased and were much different（P〈 0.001）, compared with that HR（118±5.43）min before intubation.After 4 hours of intubation HR（90±4.70）min decreased and were much different（P〈0.001）, compared with that HR（118±5.43）min before intubation; During changing intubation SAO2（95.7±0.95）% decreased but no much different（P〉 0.05）, compared with that SAO2（96.5±1.58）% before changing intubation.But the average changing intubation time（1.58±0.29）min was short and the patients can be suffered.During changing intubation HR（93.7± 5.76）min increased but no much different（P〉0.05）, compared with that HR（90.3±5.42）min before changing intubation.During intubation or changing intubation,no arrhythmia occurred and successful operation rate is 100%（60/60）.Conclusion The technique of endotracheal intubation and changing intubation under guidance of fibrebronchoscopy has many advantages such as simplity, effectivity, safety, high success rate and low complication ,so it should be popularized in clinical practices.