经纤维支气管镜引导下置放胃管在危重病人的应用

目的探讨胃管插入困难的重症患者经纤维支气管镜（以下简称纤支镜）引导下置放胃管的临床应用效果。方法三次常规徒手置胃管失败的ICU科重症患者，采用纤支镜直视下经鼻腔进入食管，导丝从活检孔插入，退出纤支镜，导丝留在食管，导丝引导下插入胃管，胃管插入预设距离后，拔出导丝，确定胃管在胃内后，固定胃管于鼻孔处。结果采用纤支镜导丝引导进行置放胃管，28例全部获得成功，成功率为100％，患者均能耐受，意识清醒者易接受，未发现明显不适或其他不良反应。结论纤支镜导线引导下置放胃管操作安全、简单、成功率高、并发症少，是需插胃管但又难以插入的危重病人的较好治疗办法。

Application of fibreoptic bronchoscope-guided gastric tube positioning in severe patients

Objective To investigate the clinical effect of fibreoptic bronchoscope （FOB）- guided gastric tube positioning in severe patients with difficulties in positioning gastric tube by routine techniques. Methods FOB-guided gastric tube positioning was applied in 28 patients in intensive care unit （ICU） who had failed for 3 times in routine placement. Firstly, the FOB was inserted into the esophagus via nasal cavity, followed by the introduction of the guidewire through the biopsy pore and withdraw of the FOB the gastric tube was finally positioned over the guidewire and fixed on the nose after the guidewire was removed. Results The method was successful in all 25 cases. Even the conscious patients could tolerate this process, with little discomfort or side effects induced.Conclusions The FOB-guided gastric tube positioning is safe, simple to perform and with high success rate and less complication. Therefore, it brings a satisfactory resolution for those severe cases of difficult gastric tube positioning.