几种有创方法用于胸外科术后呼吸道清洁的比较分析

Comparative analysis of several invasive methods in treating postoperative sputum retention

目的探讨几种有创方法用于术后进行呼吸道清洁的指征并比较其治疗效果。方法回顾性分析2002年1月至2006年12月曾接受纤维支气管镜（简称纤支镜）吸痰、环甲膜穿刺置管、气管插管或气管切开的112例患者的临床资料。其中男性95例，女性17例；年龄14～81岁，平均年龄（65．2±11．1）岁。观察PaO2、SpO2和肺不张的改善情况，并比较不同有创方式进行呼吸道清洁的治疗效果。结果纤支镜吸痰组有效率40．0％（24／60），其中36例患者还需多次纤支镜吸痰或进一步的有创方式吸痰。气管插管组有效率31．2％（15／48），有11例患者还需环甲膜穿刺、22例患者需气管切开吸痰。气管插管组和纤支镜吸痰组的术后介入时间和疗效持续时间低于经环甲膜穿刺和气管切开组。结论全面分析患者的病情有助于合理选择有效的有创呼吸道清洁方式。经气管插管和纤支镜吸痰在短期缓解患者症状方面有一定的作用，可作为胸外科术后有创方式吸痰的首选。

Objective To compare the indications and therapeutic effects of several invasive interventions in treating postoperative sputum retention. Methods Bronchoscopy, cricothyroidotomy, intubation or tracheotomy was performed in 112 patients with postoperative sputum retention from January 2002 to December 2006. There were 95 male and 17 female patients. The age ranged from 14 to 81 years old with a mean of （65.2 ± 11.1 ） years old. Their clinical data were collected to prove the improvement of PaO2, SpO2, and pulmonary atelectasis. Sputum clearance results of these invasive methods were compared as well. Results Bronchoscopies were effective in 24 out of 60 cases （40. 0% ）, while the rest 36 cases called for multiple bronchoscopies or other maneuvers. Tracheal intubations were effective in 31.2% （ 15/ 48 ） patients, among whom 11 patients required further cricothyroidotomies, and 22 patients required tracheotomies. Intubations and bronchoscopies resulted shorter intervention durations and efficacy durations, comparing with the other two methods. Conclusions Personalized risk analysis helps decision making in invasive interventions for postoperative sputum clearance. Tracheal intubations and bronchoscopic clearance are helpful in short-term symptomatic relief and recommended the first choice in cases of postoperative sputum retentions.