鼻插管在高血压脑出血术后的临床应用研究

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 ,HICH术后合并呼吸障碍需较长时间建立人工气道患者应优先考虑经纤支镜下鼻气管插管

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

OBJECTIVE: To explore the clinical signification of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage (HICH) who had respiration failure. METHODS: Ninety-four postoprative patients with HICH were divided into two 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)days, which in B group was(19.1+/-7.2)days (P<0.01). The occurent rates of combined infection in lung and double-infection were lower in A group than these in B group (56.3 percent vs. 91.3 percent, P<0.05; 10.4 percent vs. 39.1 percent, P<0.01; respectively), with their resident days shorter and prognosis better in A group than these in B group (P<0.05). CONCLUSION: The nasotracheal intubation guided with fiberbronchoscope has small trauma, lower incidence of complication, which may be considered as a better selection for the postoperative patients with HICH who had respiration failure.