鼻插管在高血压脑出血术后的临床应用研究

Study on clinical significances of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensiveint racerebral hemorrhage

目的 :探讨纤维支气管镜 (纤支镜 )下经鼻气管插管在高血压脑出血 (HICH)术后合并呼吸障碍中应用的临床意义。方法 :94例 HICH术后口插管 5～ 7d尚需留置人工气道患者 ,其中 A组 48例改经纤支镜下经鼻气管插管 ,B组 46例改气管造口。比较两组改道后的氧代谢情况、人工气道留置时间、肺部并发症发生率和预后 (P<0 .0 5 )。结果 :两种方法均能满足 HICH术后呼吸障碍患者的氧代谢或施行机械通气的需要 (P均 >0 .0 5 ) ;A组平均置管时间 (14 .2± 6.5 ) d,B组平均封口时间 (19.1± 7.2 ) d(P<0 .0 1) ;A组肺部感染和双重感染的发生率明显低于 B组 (5 6.3 %比 91.3 % ,P<0 .0 5 ;10 .4%比 3 9.1% ,P<0 .0 1) ;同时 A组住院时间短 ,预后优于 B组 (P<0 .0 5 )。结论 :鼻气管插管对机体损伤小 。

Objective: To explore the clinical signification of the applicatio n of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage (HICH) who had respiration failure. Methods: Ninetyfour postoprative patients with HICH were divided into tw o groups,A group treated with nasotracheal intubation and B group treated with tracheal incision. The oxygen metabolism, pulmonary complication incidence of two groups were analyzed and compared. Results: The basic oxygen metabolism and the need of mechanical ventilation in the cases with respiration failure were satisfying in two groups( both P> 0 05). The mean reserved time of artificial airway in A group was(14 2±6 5)d ays, which in B group was(19 1±7 2)days (P <0 01). The occurent rates of combined i nfection in lung and doubleinfection were lower in A group than these in B g roup(56 3 percent vs. 91 3 percent, P<0 05; 10 4 percent vs. 39 1 perc ent,P <0 01; respectively), with their resident days shorter and prognosis bett er in A group than these in B group(P<0 05). Conclusion: The nasotracheal intubation guided with fiberbronchos cope has small trauma, lower incidence of complication, which may be considered as a better selection for the postoperative patients with HICH who had r espiration failure.