纤支镜引导下经口气管插管机械通气在慢阻肺急性加重期患者抢救中的应用

Application of mechanical ventilation of oral tracheal intubation guided by fiberoptic bronchoscope in the rescue of patients with acute exacerbation of chronic obstructive pulmonary disease

目的探究纤支镜引导下经口气管插管机械通气在慢性阻塞性肺疾病急性加重期(AECOPD)患者抢救中的应用。方法选择我院2016年12月~2017年11月期间收治的43例AECOPD患者为对照组,2017年12月~2018年11月期间收治的43例AECOPD患者为研究组。研究组患者在纤支镜的引导下经口气管插管及纤支镜吸痰、支气管肺泡灌洗后有/无创序贯机械通气治疗,对照组在喉镜的协助下经口气管插管和负压吸痰后有/无创序贯机械通气治疗。比较两组患者一次性插管成功率、平均插管时间、出院前并发症率,插管后呼吸衰竭纠正时间、有创通气时间、肺部感染控制窗(PIC)出现时间,比较研究组患者插管前后生命体征的变化。结果研究组患者的一次性插管成功率与对照组比较显著升高(P<0.05),平均插管时间、出院前并发症率与对照组比较显著降低(P<0.05)。研究组患者插管后呼吸衰竭纠正时间、有创通气时间、PIC出现时间与对照组比较均显著降低(P<0.05)。研究组患者插管前后心率、收缩压、舒张压、指脉氧饱和度、动脉血PaO2、动脉血PaCO2等生命体征指标无显著性差异(P>0.05)。结论纤支镜在AECOPD患者抢救中能有效提高患者一次性插管成功率,缩短插管时间,减少并发症,有助于提高其治疗效果。

Objective To investigate the application of mechanical ventilation of oral tracheal intubation guided by fiberoptic bronchoscope in the rescue of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods 43 AECOPD patients admitted to our hospital from December 2016 to November 2017 were selected as the control group. 43 AECOPD patients admitted between December 2017 and November 2018 were included in the study group. Patients in the study group were treated with fiberoptic bronchoscopy, orthotopically intubated, bronchoalveolar lavage, and non-invasive sequential mechanical ventilation. The control group was treated with laryngoscope with or without invasive sequential mechanical ventilation after orotracheal intubation and vacuum suction. The success rate of one-time intubation, average intubation time, pre-discharge complication rate, respiratory failure correction time after intubation, invasive ventilation time, and time of pulmonary infection control window(PIC) were compared between the two groups. The changes in vital signs before and after intubation were compared between the study group patients. Results The success rate of one-time intubation was significantly higher in the study group than in the control group(P<0.05). The mean intubation time and pre-discharge complication rate were significantly lower than those in the control group(P<0.05). The correction time, invasive ventilation time and PIC appearance time of patients in the study group were significantly lower than those of the control group(P<0.05). There were no significant differences in vital signs such as heart rate, systolic blood pressure, diastolic blood pressure, finger vein oxygen saturation, arterial blood PaO2, and arterial blood PaCO2 before and after intubation in the study group(P>0.05). Conclusion The fiberoptic bronchoscope can effectively improve the success rate of one-time intubation in patients with AECOPD, shorten the time of intubation, reduce complications, and help to improve the therapeutic effect.