三通喉罩通气下纤维支气管镜在重症肺部感染中的应用

目的探讨三通喉罩通气下纤维支气管镜(纤支镜)对重症肺炎患者的治疗作用及安全性。方法 30例重症肺炎患者(治疗组)在快速诱导麻醉下插入三通喉罩,其标准端口连接呼吸机,另一带有密封胶帽端口置入纤支镜,实施支气管肺泡灌洗术。另选取30例重症肺炎患者作为对照组,表麻下经纤支镜常规行支气管肺泡灌洗术。观察两组术前、术中、术后心率、血压、脉搏氧饱和度的变化,并观察术后疾病的转归情况。结果治疗组全部30例手术顺利完成,三通喉罩通气不同时间点血流动力学指标稳定,通气效果良好,无明显并发症;术中治疗组心率、血压显著低于对照组(P<0.01),脉搏氧饱和度显著高于对照组(P<0.01)。总有效率治疗组(93.3%)明显优于对照组(76.7%)(P<0.05)。结论三通喉罩通气下经纤支镜治疗重症肺炎相对于常规纤支镜治疗,具有安全、可靠、并发症少、效果满意等优点。

Application of three-way laryngel mask airway ventilation in bronchoalveolar lavage by bronchofiberscopy in severe pneumonia

Objective To study the efficacy and safety of bronchofiberscope by three-way laryngeal mask airway(TLMA) ventilation in severe pneumonia patients.Methods Thirty patients with severe pneumonia admitted for tracheal intubation with TLMA under general anesthesia(the treatment group) and another 30 patients with severe pneumonia treated with bronchofiberoscopy under local anesthesia as control group.All patients were underwent broncholveolar lavage by bronchofiberscope.SBP,DBP,HR and SpO2 were measured before the surgery,during the surgery and after the surgery,observing patients’ sequelae of two groups.Results 30 operations of the treatment group were successful,hemodynamic parameters were stable at different time points,no side effect and complications were observed.BP and HR of the treatment group were significantly lower and SpO2 were obviously higher,compared to the control group(P<0.01).The general efficiency of the treatment group(93.3%) was markedly higher than that of the control group(76.7%),(P<0.05).Conclusion The study shows that TLMA for broncholveolar lavage by bronchofiberscope in severe pneumonia patients is an efficiency and safe method with fewer complications and satisfactory effects,compared with routine bronchofiberscopy.