纤维支气管镜在急危重病人气道管理中的应用

目的 探讨纤支镜在急危重病人气道管理中的作用。方法 回顾性总结支气管镜对34例重症病人进行气道管理中的清理作用及治疗咯血，肺炎及肺不张等临床经验。结果 10例肺部感染患者，经纤维支气管镜治疗后感染均得到不同程度的控制，其中6例痊愈出院；7例肺不张者，4例行纤支镜1次肺复张，1例行纤支镜2次后复张，余2例配合其它治疗措施后复张；大咯血9例患者，经纤支镜局部应用肾上腺素及凝血酶，6例咯血立即停止，3例明显减轻；机械通气患者4例，2例痰栓致肺不张，其中1例左肺不张纤支镜吸引冲洗后复张2例诊断气管插管球囊滑脱／破裂，指导换管成功。困难气管插管患者均因常规方法失败后经纤支镜引导插管成功。结论 支气管镜是对急危重症病人进行气道管理的极有价值的工具，即可用于协助气管插管，又可胜任气道的清理作用及诊治大咯血，难治性肺部感染及急性肺不张等。

The Application of Fiberoptic Bronchoscopy in Airway Management of Acute Critical Patients

Objective To investigate the effect of fiberoptic b ronchoscopy on the airway management of acute critical patients.Methods Our recent experience of application of fiberoptic bronchoscopy to clearing airway in the management of acute critical patients and to treating hemoptysis, pneumonia and atelectasis etc.was summarized. Results There were 10 case s of pulmonary infection in the study,all them were controlled with 6 cases cure d.Of 7 cases of atelectasis in the study, 4 cases were rehabilitated by fiberopt ic bronchoscopy at one time and 1 case was at second time;while remained 2 cases were rehabilitated by other therapies.There were 9 cases of massive hemoptysis, 6 cases were ceased rapidly by local affusing noradrenalin and thrombin and 3 ca ses were alleviated obviously.There were 4 cases of mechanical ventilaion in the study. Among 2 cases of sputum embolus resulting in atelectasis, 1 case of ligh t atelectasis was rehabilitated by taking lavement; the other 2 cases were succe ssfully treated by replacing prolapsus/broken trachea intubation sacculus. All p atients with difficult trachea intubation in the study were well managed by bein g intubated after the routine methods failed.Conclusion Fiberoptic bronchoscopy is a great value instrument in the airway management of acute criti cal patients,which may be applied to aid trachea intubation and be equal to clea ring airway;it may also be helpful in diagnosis and treatment of massive hemopty sis,difficult-to-control pneumonia,and acute atelectasis etc.