摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
目的:评价无创正压通气(NIPPV)在救治慢性阻塞性肺疾病(COPD)急性加重期并严重呼吸衰竭患者中的临床疗效。方法:对2006年1月至2008年1月入选的47例COPD急性加重期并严重呼吸衰竭患者使用双水平无创正压呼吸机面罩辅助通气, 患者均伴有不同程度的意识障碍,动态观察NIPPV治疗前和治疗后2 h、8 h、1 d及3 d动脉血气、神志、治疗后患者的转归,NIPPV的不良反应及并发症。结果:本组47例患者中,41例经NIPPV治疗2 h、8 h、1 d及3 d后与治疗前比较,PaO2明显升高Plt;0.01,PaCO2明显降低Plt;0.01,pH明显升高Plt;0.01,均脱机出院,有效率达87.23%(41/47);6例改为有创通气,其中3例经有创机械通气治疗后脱机成功,1例因上消化道出血死亡,2例自动出院.结论:双水平无创正压通气对有选择的COPD急性加重期并严重呼吸衰竭患者治疗疗效确切,它能迅速缓解病情,减少患者的气管插管和气管切开以及相应的并发症,提高生活质量。