气管插管引导下经硬质气管镜置入硅酮支架治疗气道狭窄的疗效

Effect of silicone stent under rigid bronchoscopy guided by endotracheal intubation in treatment of airway stenosis

目的探讨气管插管引导下置入硬质气管镜及硅酮支架治疗气道狭窄的疗效及安全性。方法选取2016年1月-2019年5月在南通市第一人民医院就诊的拟行硅酮支架置入的中心性气道狭窄患者27例,随机分为气管插管引导下插入硬镜组和直接法插入硬镜组,比较两组的硬镜插入时间,术中患者心率、血压、SPO2情况。同时比较硅酮支架置入前、术后1周患者生活质量评分、气道狭窄程度、血气分析结果、呼吸困难缓解及并发症发生情况。结果气管插管引导下插入硬镜组术中低氧血症及心动过速的发生率明显低于直接法插入硬镜组(P均<0.05),气管插管引导下插入硬镜组插入时间也明显短于直接法插入硬镜组(t=3.754,P<0.05)。硅酮支架置入术后一周患者的气道狭窄程度、呼吸困难评分较术前明显下降,氧分压、生活质量评分较术前升高(P<0.05)。无严重并发症发生。结论气管插管引导下硬镜置入安全、有效;硅酮支架是治疗良恶性气道狭窄的有效方法,临床值得推广。

Objective To explore the efficacy and safety of silicone stent under rigid bronchoscopy guided by endotracheal intubation in treatment of airway stenosis.Methods 27 patients with airway stenosis who were ready for silicone stent implantation in the First People's Hospital of Nantong from January 2016 to May 2019 were selected.They were randomly divided into the endotracheal intubation-guided rigid bronchoscope group and the conventional rigid bronchoscope group.The insertion time of rigid bronchoscopy,heart rate,blood pressure and SPO 2 were compared between the two groups.The quality of life score,airway stenosis degree,blood gas analysis results,dyspnea score and complications of patients before and 1 week after silicone stent implantation were also compared.Results The incidence of hypoxemia and tachycardia in the endotracheal intubation-guided rigid bronchoscope group was significantly lower than that in the conventional rigid bronchoscope group(P<0.05).The insertion time of the endotracheal intubation-guided rigid bronchoscope group was also significantly shorter than that of the conventional rigid bronchoscope group(P<0.05).After the placement of silicone stents,the degree of airway stenosis and dyspnea score were decreased significantly(P<0.05),while the PO 2 and quality of life score increased significantly(P<0.05).There was no serious complications occurred.Conclusion Endotracheal intubation-guided rigid bronchoscope implantation is safe and effective,and silicone stent can effectively treat benign and malignant airway stenosis,which is worthy of widely clinical application.