经纤维支气管镜肺灌洗治疗创伤性肺不张疗效分析

目的评价纤维支气管镜肺灌洗治疗创伤性肺不张44例患者的疗效。方法自2001年1月至2007年9月对44例创伤性肺不张患者（外伤后肺不张34例，肺癌术后肺不张6例，食管癌术后肺不张4例）应用纤维支气管镜吸痰及生理盐水肺灌洗方法进行治疗。结果1次灌洗肺复张者38例，2次灌洗肺复张者5例，3次灌洗复张不全者1例。本方法治疗创伤性肺不张的显效率97．7％，有效率2．3％。结论纤维支气管镜肺灌洗创伤小、并发症小、疗效确切，是治疗创伤性肺不张理想的方法。     

纤维支气管镜在治疗急性肺不张中的应用

目的探讨纤维支气管镜对急性肺不张的治疗效果。方法分析40例急性肺不张患者用纤维支气管镜吸引阻塞支气管开口处的分泌物及痰栓、血凝块,并用生理盐水反复冲洗。结果25例患者在24h内复张,11例在48h内复张,4例在72h后复张。结论纤维支气管镜吸引治疗急性肺不张的方法针对性强、安全、有效,并发症少。     

纤维支气管镜治疗肺结核咯血后急性肺不张16例

目的 探讨纤维支气管镜在治疗肺结核咯血后急性肺不张的临床价值.方法 对16例肺结核咯血后急性肺不张患者行纤支镜检查、治疗,观察安全性、并发症、疗效.结果 11例治疗1次肺完全复张,5例治疗2次肺完全复张,无意外情况发生.显效13例,有效3例,无效0例,有效率100％.结论 纤支镜对肺结核咯血后急性肺不张的治疗有重要临床价值,能迅速明确血凝块阻塞部位,有效清除血凝块,是一种安全、有效的方法.     

经纤维支气管镜灌洗治疗老年人肺炎后肺不张35例护理

目的介绍经纤维支气管镜灌洗治疗老年人肺炎后肺不张的护理配合方法。方法选取35例老年人肺炎后肺不张患者在综合治疗基础上行经纤维支气管镜灌洗术，护士在灌洗术前对患者进行全面身心评估，解除思想顾虑，完善各项术前检查；术中加强配合，密切观察病情变化；术后重视并发症的观察。结果其中30例患者经灌洗后肺复张，全部病例无严重并发症发生。结论良好的护理配合对灌洗术成功至关重要。     

床边纤维支气管镜治疗术后急性肺不张30例临床分析

目的探讨床边纤维支气管镜在ICU肺不张诊治中的临床价值。方法对30例急性肺不张患者行急诊床边纤维支气管镜检查,吸痰,局部冲洗。结果 23例肺不张患者肺复张痊愈,7例好转,未发生意外情况。结论床边纤维支气管镜在危重患者中能有效清除痰和气道分泌物,治疗急性肺不张是安全有效的,并发症少。     

支气管镜吸痰及甲硝唑灌洗治疗胸部外伤后顽固性肺不张36例临床观察

目的探讨胸部外伤后所造成的顽固性肺不张的治疗方法。方法胸部外伤后患侧肺不张的患者,经常规治疗及闭式引流5天后,肺不张仍不能恢复者,经纤维支气管镜检查、吸痰及0．2％甲硝唑支气管灌洗。结果26例患者一次治疗肺组织完全复张,10例患者经第二次治疗后肺组织完全复张,治愈率100％。结论气管镜吸痰及甲硝唑灌洗治疗胸部外伤后顽固性肺不张是一种非常有效的治疗方法。     

床边支气管肺泡灌洗治疗术后肺不张

目的探讨床边纤维支气管镜支气管肺泡灌洗治疗术后肺不张的效果及安全性。方法术后肺不张患者25例在床边监护吸氧或机械通气下,表面麻醉后纤维支气管镜插至堵塞部进行支气管肺泡灌洗,观察对比检查前后的胸片、临床表现、经皮血氧饱和度等指标。结果发现22例患者粘稠痰液阻塞一侧主支气管或叶支气管,为阻塞性肺不张,3例在支气管腔内只有少许黏液,为非阻塞性肺不张,治疗后肺完全复张21例(84%),部分肺复张3例(12%),未复张1例(4%);临床表现、血氧饱和度和X线胸片有不同程度改善者24例(94%)。结论术后肺不张均为炎症导致大量痰液堵塞支气管引起,纤维支气管镜床边支气管肺泡灌洗治疗术后肺不张效果确切、安全。     

纤支镜灌洗治疗创伤性肺不张的临床疗效观察

目的 探讨纤维支气管镜（纤支镜）灌洗治疗创伤性肺不张的临床疗效.方法对38例创伤性肺不张患者在常规治疗的基础上进行纤支镜吸痰及灌洗术,每日1~2次,并观察肺不张改善情况.结果 完全治愈37例,占97.4%,其中灌洗1次者26例,2次者9例,3次者2例,灌洗后1d内肺复张者23例,2d内肺复张者11例,3d内复肺复张者3例.1例患者因肺复张不全继发重症肺部感染致多器官功能衰竭而放弃治疗.本组所有病例在灌洗过程中均未发生严重并发症.结论纤支镜灌洗治疗肺不张的临床疗效显著,操作简便,安全可靠,值得推广应用.     

电子支气管镜灌洗联合高氧正压鼓肺治疗肺挫伤性肺不张的临床价值

目的探讨床边电子支气管镜灌洗后高氧正压鼓肺治疗肺挫伤性肺不张的临床价值。方法对照组30例,常规治疗方案抗感染、平喘解痉化痰、雾化吸入、吸氧吸痰止痛等综合治疗。治疗组30例,在常规治疗的基础上,床边电子支气管镜吸痰灌洗后,高氧接上呼吸囊,插入支气管镜活检孔鼓肺,每日2次。观察肺不张和肺挫伤的改善情况。结果治疗组症状、体征改善快,肺挫伤、肺不张好转快,肺复张时间平均4.5d,比对照组提前6.1d。治愈率为86.6%,比对照组上升30%（P〈0.05）。结论床边电子支气管镜灌洗高氧正压鼓肺在提高肺挫伤性肺不张的治愈中起着重要作用。     

纤维支气管镜在肺不张病因诊断及治疗中的应用

采用纤维支气管镜（下称纤支镜）对110例肺不张患者进行病因诊断及辅助治疗。结果本组肺不张病因为肺癌68例、炎症21例、结核13例、黏液栓8例；经纤支镜吸痰、冲洗、止血等治疗后49例患者肺不同程度复张。认为纤支镜对肺不张的病因诊断与治疗均有重要价值。     

Alveolar proteinosis. Lobar lavage by fiberoptic bronchoscopic technique.

Lavage limited to an isolated lobe was performed on multiple occasions using a cuffed fiberoptic bronchoscope in a patient with alveolar proteinosis. Sequential ventilation-perfusion scintiphotoscans were used to preselect and follow the functional behavior of the lavaged lobe. Lavage led to functional improvement. The technique of fiber-optic bronchoscopic lobar lavage is simple and may find application in patients in whom lavage of an entire lung may be hazardous.     

Pulmonary alveolar proteinosis: treatment by bronchofiberscopic lobar lavage

The current mainstay of treatment for pulmonary alveolar proteinosis (PAP) is whole-lung lavage. Therapy with granulocyte-macrophage colony-stimulating factor is a possibility, although its long-term safety has not been determined. An alternative procedure is selected lobar lavage by fiberoptic bronchoscopy (FOB). We report here our experiences with lobar lavage by FOB in treating three patients with PAP. PAP was diagnosed in three patients (two men, one woman) who had dyspnea and hypoxemia after undergoing open-lung biopsy. The patients underwent lobar lavage by FOB under local anesthesia. The bronchoscope was wedged into a lobar bronchus. Approximately 2,000 mL warm normal saline solution was instilled via syringe in 50-mL aliquots through a fiberoptic bronchoscope. After undergoing multiple lobar lavages, two patients showed clinical, physiologic, and radiologic improvement. The third patient, who had more advanced disease, showed improvement only in oxygenation. The major complications were severe cough and hypoxemia during lavage. Our experience suggests that bronchoscopic lobar lavage is simple and safe, and may find application in patients in whom a whole-lung lavage with generalized anesthesia may be hazardous, and in patients with less advanced disease whose proteinaceous substances can be removed with a small volume of lavage fluid.     

肺泡灌洗术与纤支镜在慢阻肺合并肺不张中的诊断与治疗研究

目的探讨肺泡灌洗术与纤维支气管镜在慢性阻塞性肺疾病合并肺不张的临床诊断及治疗中的价值。方法选择80例因感染致慢阻肺合并肺不张接受治疗的患者作为研究对象,其中42例患者进行纤支镜肺泡灌洗术治疗作为试验组,38例患者采用单纯纤支镜吸痰治疗作为对照组,比较两组的正确检出率、血气分析、肺复张及转归情况。结果病原体检测结果显示试验组细菌检出率为100%,对照组细菌检出率为86.84%,两组差异具有统计学意义(P0.05)。两组患者治疗前后血气分析指标均有明显改善,表现为Pa O2升高,Pa CO2降低,且差异均有统计学意义(P0.05),但是试验组改变更明显;试验组肺复张率为88.09%,明显高于对照组(P0.05)。42例试验组总有效率为92.86%,显著高于对照组(72.32%),两组差异具有统计学意义(P0.05)。结论对于分泌物较多致气道阻塞的慢阻肺合并肺不张患者,及时给予纤支镜吸引和肺泡灌洗,可以迅速通畅气道,使肺不张得以肺复张,加之其有安全有效、技术掌握性强的优势,值得广泛推广。     

CO2冷冻联合钳夹治疗婴幼儿淋巴结瘘型气管支气管结核的疗效和安全性研究

目的: 评估CO₂冷冻联合钳夹介入治疗对婴幼儿淋巴结瘘型气管支气管结核(tracheobronchial tuberculosis,TBTB)的疗效和安全性。方法: 回顾性分析2012年7月至2020年7月天津市儿童医院呼吸科接受纤维支气管镜介入治疗的7例淋巴结瘘型TBTB患儿的临床资料(包括年龄、性别、临床症状、诊断结果、CT特点、支气管镜下病灶特征),通过描述性总结分析介入治疗前后的咳嗽等级、CT及支气管镜下病灶改变。结果: 7例患儿中,男6例,女1例,年龄8个月至3岁,病程5~70d。所有患儿主要采用支气管镜下CO₂冷冻联合钳夹治疗,介入次数为1~3次。介入治疗3个月后,5例患儿咳嗽评分从2分降为0分,治疗显效,2例患儿咳嗽评分从3分降为1分,治疗有效;5例患儿复查CT显示:肺门、纵隔肿大钙化的淋巴结、支气管阻塞、肺气肿、肺不张等表现与介入治疗前比较明显改善和好转。5例患儿中,4例患儿肺部病灶吸收≥1/2,治疗显效,1例患儿肺部病灶吸收<1/2,治疗有效。7例患儿复查纤维支气管镜可见镜下瘘口基本闭合,支气管病变明显吸收好转,管腔狭窄或阻塞情况较前减轻,支气管黏膜相对光滑。7例患儿中,5例患儿支气管病变吸收≥2/3,治疗显效,2例患儿支气管病变吸收好转但<2/3,治疗有效。所有患儿术中均无呼吸困难及血氧饱和度的下降。所有患儿术后均未出现气胸、纵隔气肿、气道痉挛、管腔水肿、大出血等严重并发症。应用纤维支气管镜介入随访3~6个月,除1例患儿失访,6例患儿均未见病灶复发。结论: CO₂冷冻联合钳夹介入治疗婴幼儿淋巴结瘘型TBTB取得良好的治疗效果,未见气管支气管狭窄、软化、阻塞性肺炎、肺不张等合并症的发生,该治疗方式安全有效。     

纤维支气管镜治疗胸腹部手术后肺不张

目的 探讨纤支镜治疗胸及上腹部手术后肺不张的效果。方法 术后肺不张患28例，均做纤支镜检查，吸出痰液或支气管冲洗。结果 发现23例患粘稠痰液阻塞一侧主支气管或叶支气管，为阻塞性肺不张；5例在气管腔内只有少许粘液，为非阻塞性肺不张。27例经治疗后肺完全复张，1例纤支镜术后不久死亡。结论 对胸及上腹部术后肺不张的患，用纤支镜检查和治疗是较为安全有效的方法，但仍应做好抢救准备。     

纤支镜在老年急性重症肺部感染并肺不张的治疗体会

目的探讨纤维支气管镜（纤支镜）在老年急性重症肺部感染并肺不张的应用价值。方法对34例经内科常规治疗效果不佳的老年急性重症肺部感染并肺不张患者,行纤支镜吸痰及支气管肺泡冲洗术（BL）。结果所有病例经治疗后均取得良好效果,肺复张率为100%,无严重并发症及意外发生。尤其对术后肺部感染并肺不张,经床边纤支镜吸痰及BL治疗,疗效显著。结论纤支镜对老年急性重症肺部感染并肺不张治疗效果好,安全可行,值得进一步推广应用。     

经纤维支气管镜留置肺导管给药对支气管内膜结核的治疗观察

目的探讨经纤维支气管镜留置肺导管用药治疗支气管内膜结核的方法与疗效。方法在全身抗痨治疗的基础上,经纤维支气管镜留置肺导管,每日将抗结核药物注入支气管内膜结核病灶处。结果肺导管局部给药加全身抗痨组的总有效率、2个月结核菌转阴率均优于单纯全身抗痨组。结论肺导管局部给药加全身抗痨治疗支气管内膜结核疗效显著,值得推广应用。     

纤维支气管镜检查在肺不张病因诊断中的价值

目的探讨纤维支气管镜检查对肺不张病因诊断的价值。方法对238例肺不张患者的纤维支气管镜检查结果进行分析。结果228例获得病因诊断,诊断率为95.8%,其中肺癌178例(74.2%),结核25例(10.5%),炎症17例(7.1%),异物8例(3.4)。结论纤维支气管镜检查在肺不张的病因诊断中具有重要价值,能提高诊断率。     

The use of the pediatric fiberoptic bronchoscope in adults

Standard fiberoptic bronchoscopes with external diameters of more than 4.5 mm are commonly used to diagnose pulmonary diseases in adults. A smaller bronchoscope with an external diameter of 3.5 mm has been in use to examine pediatric airway disorders. Three adult patients, 2 with hemoptysis and 1 with cough, when examined using the standard fiberoptic bronchoscope, had nondiagnostic findings. Subsequent examination using the pediatric fiberoptic bronchoscope revealed endobronchial lesions in all 3 patients. On the basis of the findings of pediatric bronchoscopic examination, it was possible to provide appropriate therapeutic decisions, which may not have resulted from the standard bronchoscopic examinations. The smaller external diameter of the pediatric bronchoscope will enable the bronchoscopist to detect endobronchial lesions in smaller airways that cannot be visualized by the standard fiberoptic bronchoscopes.     

Diagnosis of pneumonia due to Pneumocystis by subsegmental pulmonary lavage via the fiberoptic bronchoscope.

To assess the accuracy of pulmonary lavage in diagnosing pneumonia due to Pneumocystis, we used animals as a model and then prospectively studied 33 immunosuppressed adults with diffuse pulmonary infiltrates. In rats treated with cortisone, Pneumocystis organisms could be found in the effluent from lavage as early as in sections of pulmonary tissue, and the effluent from lavage remained diagnostic throughout the ten weeks of observation. Subsegmental lavage in adult patients was performed through the wedged fiberoptic bronchoscope. Pneumocystis organisms were demonstrated in seven patients by lavage, and no false-negative results were recorded. Pneumocystis organisms were readily identified among the sheets of alveolar macrophages seen in smears of the effluent from lavage that were stained with methenamine silver. Subsegmental lavage via the fiberoptic bronchoscope is an accurate and safe technique for establishing the diagnosis of pneumonia due to Pneumocystis in patients whose respiratory embarrassment or thrombocytopenia makes biopsy of the lung hazardous.