郑香香 韩素红 张鹏 成艳红 吕金堂 刘羽翔

[摘要] 目的 探讨纤维支气管镜（纤支镜）在住院卧床患者气道管理中的治疗作用及不良反应。 方法 回顾性总结2014年1～12月我科行纤支镜为117例住院卧床、外科术后痰多、肺实变不张、气管插管、气管切开的患者行吸痰、清除呼吸道痰痂等治疗的临床经验，并留取痰标本培养，对血气分析指标及胸片进行前后自身对照。 结果 110例患者经纤支镜吸痰或清除痰痂治疗后，体温下降，呼吸困难症状明显改善，肺部感染情况均得到不同程度的控制，显效率高达79.49%。治疗前后血浆pH值有所升高，但差异无统计学意义（P>0.05）。治疗后血氧分压显著提高（P<0.05）。纤支镜操作前后呼吸、脉搏、血压变化均无统计学意义（P>0.05）。未出现不良反应。 结论纤支镜及时迅速清除住院卧床患者痰痂及分泌物，有效控制肺部感染，疗效显著，缩短住院天数，在急危重困难插管中发挥着重要作用，操作简便，不良反应少，值得基层医院临床推广。

[关键词] 纤维支气管镜；气道管理；卧床；肺部感染；临床推广

[中图分类号] R459.7 [文献标识码] B [文章编号] 1673-9701（2015）34-0031-03

Effects of fiber bronchoscope on airway management for hospitalized bed patients

ZHENG Xiangxiang HAN Suhong ZHANG Peng CHENG Yanhong LV Jintang LIU Yuxiang

Department of Respiratory Medicine， Beijing Jiangong Hospital， Beijing 100054， China

[Abstract] Objective To explore the therapeutic effects and side effects on airway management of fiber bronchoscope （FB） among hospitalized bed patients. Methods A total of 117 hospitalized bed patients，who had acquired excessive phlegm after operation， pulmonary consolidation and atelectasis，trachea cannula and tracheotomy from January to December 2014， had been retrospectived summary of clinical experience including the treatment sputum aspiration，cleaned out sputum scab in respiratory tract. collected sputum sampling and compared the indexes of blood gas analysis and chest X-ray before and after FB carrying out. Results There were 79.49% of 110 patients with decreasing temperature，improving in dyspnea， different level control of pulmonary infection. Before and after treatment，the plasma pH value was increased， but without statistical significance（P>0.05）. After treatment， the blood oxygen partial pressure was significantly improved （P<0.05）. The changes of respiration， pulse and blood pressure before and after the operation were not statistically significant（P>0.05）. Conclusion FB can timely and quickly remove the sputum scab and secretion， effectively control pulmonary infection， have remarkable curative effects， and shorten the length of hospitalization. It plays an significant role in acute and severe difficult intubation， and it is easy to operate and cause few side effects as well，so it is worth promoting in elementary clinical hospitals.

[Key words] Fiber bronchoscope； Airway management； Sickbed； Pulmonary infection； Clinical promotion

近年来，由于环境逐渐恶化，呼吸道疾病的患者与日俱增，纤支镜在呼吸系统疾病诊断与治疗方面的应用也随之越来越广[1]。同时配合深部细菌学、细胞生物学、活检来对呼吸系统疾病进行辅助诊断[2]。随着我科纤支镜操作技术的日益成熟，纤支镜对危重患者气管管理的作用日益受到重视[3]。结合我院自2014年1～12月先后在呼吸、ICU、胸外、脑外、普外、心外、消化等科室开展床边纤支镜检查，对117例卧床患者行纤支镜检查和治疗，取得显著疗效，现报道如下。