实时超声监测下选择性患侧肺复张治疗的观察

Observation of the treatment of selective pulmonary reexpansion of the affected side under the monitoring of real-time ultrasound

目的 探讨实时肺部超声监测下选择性患侧肺支气管插管联合支气管镜及膨肺技术治疗肺不张的临床效果。方法 选择嘉兴市第一医院2012年10月-2016年4月ICU肺不张者44例,随机分成两组,A组（n=22）行胸部实时超声监测下进行支气管插管联合支气管镜吸痰及膨肺,B组（n=22）在胸部听诊下进行支气管插管联合支气管镜吸痰及膨肺。观察治疗过程中所需气道压力及治疗前、中、后（膨肺结束机控呼吸时）患者平均动脉压（MAP）、心率（HR）和脉搏氧饱和度（Sp O2）的变化,监测治疗前后动脉血气分析,术后第1、7天以胸部CT评判疗效。结果两组患者Sp O2治疗前后比较差异均有统计学意义（P〈0.05）;治疗过程中A组气道压明显低于B组（P〈0.05）,治疗中A组MAP（t=8.53,P〈0.05）和HR（t=-6.218,P〈0.05）较B组稳定,差异有统计学意义;A组Pa O2/Fi O2在治疗结束后第1、3、7 d明显高于B组,差异有统计学意义（P〈0.05）,术后第7天CT显示A组疗效明显高于B组,差异有统计学意义（P〈0.05）。结论 在超声监测下选择性支气管插管膨肺治疗肺不张效果较传统听诊法复张成功率高,且及时、床旁、安全、高效,值得临床推广应用。

Objective To explore the clinical effects of selective pulmonary bronchial intubation of the affected side combined with bronchoscopy and lung inflation technology in the treatment of pulmonary atelectasis under the monitoring of real-time pulmonary ultrasound. Methods A total of 44 patients with pulmonary atelectasis who were admitted to Jiaxing First Hospital from October 2012 to April 2016 were selected. They were randomly assigned to two groups. Group A （n=22） was given bronchial intubation combined with bronehoscopy aspiration of sputum and lung inflation under the monitoring of chest real-time ultrasound. Group B （n=22） was given bronchial intubation combined with bronehoscopy aspiration of sputum and lung inflation under chest stethoscope. Airway pressure needed during the treatment, as well as patients＇ MAP, HR and SpO2 changes before the treatment, during the treatment and after the treatment （after lung inflation and during machine-controlled breathing） were observed, and arterial blood gas analysis before and after the treatment was monitored. Chest CT was performed 1 day after the surgery and 7 days after the surgery to evaluate the curative effects. Results SpO2 before and after the treatment was compared in the two groups of patients, and the differences were both statistically significant （P〈0.05）; airway pressure in group A during the treatment was significantly lower than that in group B（P〈0.05）. MAP（t=8.53, P〈0.05） and HR（t=-6.218, P〈0.05） in group A during the treatment were more stable than those in group B, and the differences were statistically significant; PaOJFiO2 1 day, 3 days and 7 days after the treatment in group A was significantly higher than that in group B, and the differences were statistically signifieant（P〈0.05）. Conclusion Selective bronchial intubation combined with lung inflation technology in the treatment of pulmonary atelectasis under the monitoring of real-time pulmonary ultrasound has higher reexpansion rate than the traditional stethoscopy. It is also timely, bedside, safe, highly effective and worthy of clinical promotion and application.