摘要
目的回顾性探讨床旁纤维支气管镜（纤支镜）在肝移植术后急性肺损伤（ALI）治疗中的临床应用价值。方法将58例肝移植术后各种原因导致的ALI患者按是否采用纤支镜干预治疗分为纤支镜治疗组（36例）和常规治疗组（22例），通过比较两组重症加强治疗病房（ICU）停留时间、机械通气时间、ALI病死率、急性呼吸窘迫综合征（ARDS）进展率及其病死率，以及纤支镜使用前后的动脉血气分析变化等，评价纤支镜治疗肝移植术后ALI的临床疗效。结果与常规治疗组比较，纤支镜治疗组的ICU停留时间[（11±4）d比（16±4）d]、机械通气时间[（9±5）d比（14±5）d]均明显缩短（P均〈0．01），ALI病死率（11．1％比36．4％）及ARDS进展率（27．8％比54．5％）明显降低（P〈0．05和P〈0．01），而ARDS病死率无显著变化[40．0%（4／10）比66．7%（8／12），P〉0．05]；纤支镜治疗后动脉血氧分压（PaO：）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）及氧合指数（PaO2／FiO2）均明显好转，与治疗前比较差异均有统计学意义（P均〈0．01）。结论纤支镜是肝移植术后ALI安全、有效的治疗方法，值得推广。
Objective To evaluate retrospectively the clinical therapeutic effects of the application of bronchofibroscopy（BFS） in the treatment of acute lung injury （ALI） after liver transplantation. Methods Fifty-elght patients with ALI caused by various kinds of reasons after liver transplantation were divided into two groups depending on whether the BFS was undertaken （group A, n=36） or not （group 13, n=22）, and the clinical therapeutic effects were evaluated by comparing the length of intensive care unit （ICU） stay and mechanical ventilation, mortality rate of ALI, morbidity and mortality rate of acute respiratory distress syndrome （ARDS） and changes in arterial blood gas analysis before and after BFS treatment. Results The length of ICU stay [（11± 4） days vs. （16± 4） days] and mechanical ventilation [（9 ± 5） days vs. （14± 5） days, both P〈0. 01] in group A were shorter, and mortality rate of ALI （11. 1% vs. 36.4%）, morbidity rate （27.8% vs. 54.5%, P〈0. 05 and P〈0.01） and mortality rate of ARDS [40. 0% （4/10） vs. 66. 7% （8/12）] were lower in group A compared with group B （P〉0. 05）. Arterial partial pressure of oxygen （PaO2）, partial pressure of carbon dioxide （PaCO2）, arterial oxygen saturation （SaO2）, and oxygenation index （PaO2/FiO2） after treatment were much better than those before BFS in group A and the differences were significant （all P〈0. 01）. Conclusion BFS is a kind of safe and effective treatment measure for ALI after liver transplantation and is worthwhile to recommend.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2008年第5期264-267,共4页
Chinese Critical Care Medicine
基金
国家卫生部部属临床学科重点项目资助（98040362）
关键词
纤维支气管镜
肝移植
肺损伤
急性
回顾性研究
bronchofibroscope
liver transplantation
acute lung injury
retrospective study
