摘要
目的探讨电子支气管镜在接受机械通气的肝衰竭患者中的临床应用价值。方法对358例在ICU接受机械通气的肝衰竭患者进行了床旁电子支气管镜检查,人工气道位置判断,并进行肺泡灌洗、吸痰、气道异物吸出、病原学检查以及可能的气管导管位置调整,最后对其应用价值进行分析。结果 358例患者中,304例合并肺炎经电子支气管镜吸痰及支气管肺泡灌洗等治疗后,明确病原学证据247例(81.25%),比较24 h胸片,明显改善者106例(34.87%);54例(17.76%)通气障碍患者经电子支气管镜检查明确原因,其中27例为人工气道梗阻、痰痂或血痂形成,经电子支气管镜反复吸取,成功解除气道梗阻;21例为气管插管或套管易位、顶端贴气管壁,在电子支气管镜协助下调整或更换套管;6例肝衰竭存在肺不张患者经电子支气管镜吸痰治疗后全部复张。结论针对机械通气的肝衰竭患者,电子支气管镜在直视下吸痰、调整导管位置或留取标本,可有效减少气道出血等并发症的发生,从而安全、有效清除气道内分泌物,及早获得病原学结果,及时指导临床抗生素的应用。
Objective To investigate the clinical application of bedside electronic bronchoscope in patients with liver failure receiving mechanical ventilation support. Methods Bedside electronic bronchoscope was performed in 358 patients with liver failure receiving mechanical ventilation support in the intensive care center for checking artificial airway position, bronchoalveolar lavaging, suction of sputum, foreign bodies or mucus secretions, etiological examination and adjustment of tracheal catheter position. The application value ofbedside bronchoscope was evaluated. Results Of the 358 patients, 304 patients were complicated by pneumonia. After being treated with electronic bronchoscope for sputum suction and bronchoalveolar lavaging in the 304 patients, evidences of etiology were found in 247 patients（81.25%）; chest X-ray showed significant improvement in 106 patients（34.87%）; the causes of ventilation disorders were found in 54 patients（17.76%）, including artificial airway obstruction and formation of sputum or blood scab in 27 patients, in whom artificial airway obstruction was relieved after treatment, tracheal tube translocation in 21 patients, in whom tracheal tube was adjusted or replaced by using electronic bronchoscope, and pulmonary atelectasis in 6 patients, who achieved lung recruitment after sputum suction using electronic bronchoscope. Conclusion For patients with liver failure receiving mechanical ventilation support, the electronic bronchoscope can be used for sputum suction, adjusting catheter position and getting etiological specimen under direct vision, and effectively reduce the complications such as airway injury and bleeding, so that airway secretions can be removed safely and effectively, and etiological evidence be obtained early so as to guide the clinical application of antibiotics timely.
出处
《传染病信息》
2016年第3期167-169,共3页
Infectious Disease Information
关键词
支气管镜
肝功能衰竭
通气机
机械
bronchoscopes
liver failure
ventilators
mechanical
