经可弯曲支气管镜介入治疗气管狭窄性呼吸衰竭

Intervention with flexible bronchoscopy in patiens with respiratory failure caused by tracheal stenosis

目的探讨喉罩通气全身麻醉下经可弯曲支气管镜介入治疗气管严重狭窄导致的呼吸衰竭的治疗效果并评价其有效性、安全性。方法回顾性分析2009年9月至2012年3月16例因气管严重狭窄导致的呼吸衰竭收治于南京医科大学第一附属医院的患者介入治疗前和治疗后临床资料。喉罩通气全身麻醉下，经喉罩进出可弯曲支气管镜，通过支气管镜工作孔道进行冷冻治疗、电灼术、球囊扩张及自膨胀金属支架置入等综合呼吸介入治疗，根据患者CT和气管镜资料评估介入治疗前后气管狭窄程度及气促症状评分值。计量资料以均数±标准差（石±s）表示，治疗前后两组问均数比较采用配对t检验。结果16例气管严重狭窄导致的呼吸衰竭患者经呼吸介入治疗后气管阻塞程度由术前的（85．0±8．4）％下降至（20．9±7．6）％（P〈0．01），气促症状评分由术前（3．9±0．3）降至（2．4±0．5）（P〈0．01）。介入治疗过程中未出现1例大出血、死亡等严重并发症。结论对于气管狭窄导致的呼吸衰竭患者，喉罩通气全身麻醉下经可弯曲支气管镜进行呼吸介入治疗安全、有效。

Objective To investigate the efficiency and safety of intervention with flexible bronehoseope under general anesthesia by using laryngeal mask in patients with severe tracheal stenosis- induced respiratory failure. Methods A total of 16 in-patients with respiratory failure caused by severe tracheal stenosis admitted from September 2009 to March 2012 were retrospectively reviewed. A comprehensive bronchoscopic intervention for the complete patency of airway was successfully performed with various techniques such as cryotherapy, electrocautery, balloon dilatation, and implantation of self- expanding metal stents under genersl anesthesia by using laryngeal mask. The efficiency of comprehensive bronehoscopic intervention and dyspnea score were evaluated by chest CT scan and bronchoscopic examination before and after the treatment. Data were expressed as （ x ± s ）. Paired t test was used for statistical analysis of the data. Results The degrees of tracheal stenosis and dyspnea score before and after intervention were （85.0±8.4）% vs. （20.9±7.6）% （P〈0.01） and （3.9±0.3vs. 2.4±0.5, P〈 0. 01 ） , respectively. There were no life-threatening complications occurred including massive haemorrhage. Conclusions It is an effective and safe technique to resolve the tracheal stenosis-induced respiratory failure with intervention by using flexible bronchoscope under general anesthesia with laryngeal mask, and it is a promising interventional treatment for clinic application.