纤支镜检查联合气囊漏气实验对颈椎前路手术患者拔除气管插管后气道阻塞风险评估的价值

The value of fiberoptic bronchoscopy combined with cuff leak test in risk assessment of airway obstruction after tracheal extubation in patients with anterior cervical surgery

目的探索纤支镜检查联合气囊漏气实验对颈椎前路手术患者拔除气管插管后气道阻塞风险评估的价值。方法选取2015年7月24日至2017年10月31日在本院行颈椎前路，手术术后需拔除气管导管的86例患者，分为两组，采用纤支镜检查联合气囊漏气实验对气道阻塞风险评估方法的患者为A组（n=37），采用经验性拔管的患者为B组（n=49），比较两组患者的拔除气管插管成功率、病死率等指标。结果A组气管插管时间和ICU住院时间缩短，呼吸机相关性怖炎发生率降低，拔除气管插管成功率为100．0％、病死率为0．0％；B组气管插管时间和ICU住院时间延长，呼吸机相关性怖炎发生率增加，拔除气管插管成功率为91．8％、病死率为8．2％；两组比较差异有统计学意义（P〈0．5）。A组还发现3例患者喉头明显水肿，予延长带管时间后拔管成功，3例咳痰无力者予行气管切开，避免了拔管后因喉头水肿需要再次气管插管或气道梗阻导致死亡的发生。结论对于颈椎前路手术术后需拔除气管插管患者，通过纤支镜检查联合气囊漏气实验能有效评估拔管后发生气道阻塞的风险，明显提高了拔管的安全性。还能缩短气管插管留置时间，降低呼吸机相关性怖炎发生率，缩短ICU住院时间，从而减轻患者经济负担。

Objective To explore the value of fiberoptic bronchoscopy combined with cuff leak test in risk assessment of airway obstruction after tracheal extubation in patients with anterior cervical surgery. Methods A total of 86 patients who required tracheal extubation after anterior cervical surgery in our hospital from July 24, 2015 to October 31, 2017 were divided into two groups. In group A （n=37）, the risk of airway obstruction was assessed by fiberoptic bronchoscopy combined with cuff leak test; in group B （n=49）, the risk of extubation was assessed through clinical experience. The success rate of tracheal extubation and the mortality were compared between the two groups. Results The time of tracheal intubation mad ICU hospital stay were shorter in group A, the incidence of ventilator-associated pneumonia was lower in group A, the success rate of tracheal extubation was 100.0%, mad the mortality was 0.0%. The success rate of txacheal extubation was 91.8%, and the mortality was 8.2% in group B. The differences between the two groups were statistically significant （P〈0.05）. 3 patients were found significant laryngeal edema in the group A, and tracheal extubation was successful after prolonged tube time. 3 patients with expectoration weakness were given tracheotomy. It was necessary to avoid the occurrence of death due to the repeated intubation or obstruction of the airway due to laryngeal edema. Conclusion For the patients who require tracheal extubation after anterior cervical surgery, fiberoptic bronchoscopy combined with cuff leak test can effectively assess the risk of airway obstruction, significmatly improve the security, shorten the duration of tracheal intubation, reduce the incidence of ventilator associated pneumonia, shorten the length of hospital stay in ICU, so it can reduce the economic burden on patients.