摘要:目的：探討纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應用價值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機分為纖支鏡經口引導氣管插管組(纖支鏡組)125例和喉鏡經口引導氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導下按常規進行氣管插管術。結果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現咽喉部少量出血,并發癥發生率為40%;喉鏡組共有12例發生并發癥,并發癥發生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側肺通氣1例,插入食管2例,心跳呼吸驟停1例。結論：纖支鏡經口引導氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡便快速、成功率高和并發癥少的有效方法,值得臨床推廣應用。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 探討使用雙水平氣道正壓通氣（BiPAP）無創呼吸機對需長期輔助機械通氣的患者進行有創機械通氣的可行性。方法 選擇2004年6月~2007年11月，因呼吸衰竭入住呼吸ICU，經面罩機械通氣等方法撤機失敗或不能進行面罩機械通氣的11例患者，給予氣管切開，更換BiPAP無創呼吸機行有創機械通氣，觀察改用無創呼吸機前后動脈血氣、住院時間、出院（或達到出院標準）后存活時間等指標。結果 無創通氣吸氣壓力設定為16~26 cm H2O，平均21.3 cm H2O，呼氣壓力4 cm H2O，呼吸頻率16次/min。患者的平均住院（或達到出院標準）時間為（91.5±50.2）d，改為BiPAP呼吸機后平均住院（或達到出院標準）時間為（23.5±12.2）d。出院（或達到出院標準）后平均存活時間為（353.1±296.5）d，截至隨訪結束（2008年1月13日）有4例患者仍存活。BiPAP呼吸機使用前后動脈血pH、PaCO2、PaO2及SaO2均無顯著差異（P均gt;0.05）。結論 對于臨床穩定、仍需長期機械通氣的呼吸衰竭患者，使用BiPAP無創呼吸機通過氣管切開行有創機械通氣是可選擇的方法。
