催眠镇痛肌松下选择性患侧肺控压吹张治疗术后顽固性肺不张的疗效

Effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperativelyintractable atelectasis in hypo-analgesia and muscle relaxation

目的探讨选择性患侧肺支气管插管控压吹张治疗术后顽固性肺不张的临床效果。方法将嘉兴市第一医院2005年1月至2010年5月18例接受纤维支气管镜吸痰、胸腔闭式负压引流、拍背、吹气球等常规综合治疗7d仍不能使患肺复张者在催眠镇痛术下行支气管插管选择性患侧肺控压吹张治疗，由胸部听诊及次日胸部X线片评判疗效。结果术后第2天复查X线胸片，15例患者（83．3％）萎陷肺已全部复张，3例患者萎陷侧肺复张不完全，经第2次控压膨肺治疗后2例复张成功（11．1％，总有效率94．4％），另1例患者经3次膨肺治疗仍无效（5．6％）。期间患者生命体征稳定，无插管损伤及其他并发症发生。结论在催眠镇痛肌松下由纤维支气管镜引导选择性支气管插管控压吹张治疗术后顽固性肺不张是切实可行的。

Objective To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis. Methods For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning, closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day. Results Collapsed lung tissue were examined in 15 patients （83.3%） after the first treatment and in 2 patients （ 11. 1% ） after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred. Conclusion Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.