早期支气管镜配合机械通气治疗重型颅脑损伤致呼吸衰竭并气道误吸的应用

目的探讨纤维支气管镜（纤支镜）配合有创机械通气治疗在重型颅脑损伤致呼吸衰竭（呼衰）并气道误吸治疗中的价值及安全性。方法对32例重型颅脑损伤致呼衰并气道误吸的患者于伤后3h内实施有创机械通气支持下经纤支镜作支气管肺泡灌洗术，观察术前、中、后心率（HR）、血压（BP）、动脉血氧分压（PaO2）、氧合指数（OI）、吸气峰压（PIP）、吸氧浓度（FiO2）变化。结果32例患者均术程顺利，未发生并发症。术中HR、BP、PaO2、OI较术前无改变（P〉0.05），术后FiO2较术前显著减少，HR、PaO2、OI明显好转（P〈0.01）。经治疗无一例出现吸入性肺炎及阻塞性肺不张。结论经纤支镜支气管肺泡灌洗配合机械通气治疗，对防止吸入性肺炎及阻塞性肺不张的发生，预防和纠正低氧血症，保证脑供氧，提高救治成功率及改善预后有重要价值，并具有良好的安全性。

Application of bronchoscope cooperating with mechanical ventilation in treating respiratory failure and airway wrong inhalation due to severe craniocerebral trauma at early stage

Objective To study the value and safety of fiber bronchoscope cooperating with mechanical ventilation in the treatment of respiratory failure and airway wrong inhalation due to severe craniocerebral trauma.Methods A total of 32 patients with respiratory failure and wrong inhalation due to severe craniocerebral trauma underwent bronchoalveolar lavage with the aid of fiber bronchoscope supported by invasive mechanical ventilation within 3 h after injury,and the data of heart rate(HR),blood pressure(BP),PaO2,oxygenation index(OI),peak inspiratory pressure(PIP),FiO2 were recorded before,during,and after the treatment.Results Bronchoalveolar lavage in all 32 cases was smoothly carried out without complications.HR,BP,PaO2 and OI remained stable and did not change after treatment as compared with before treatment(P>0.05),and FiO2 is obviously reduced after the treatment while obvious improvement is recorded in HR,PaO2 and OI after treatment(P<0.01).No aspiration pneumonia and obstructive atelectasis occured.Conclusion Bronchoalveolar lavage using fiber bronchoscope cooperating with mechanical ventilation is of great value to avoid aspiration pneumonia and obstructive atelectasis,to prevent and correct hypoxemia,to assure cerebral oxygen supply,to increase successful resuscitation rate and to improve prognosis in the treatment of respiratory failure and airway wrong inhalation due to severe craniocerebral trauma.