无创通气辅助内镜治疗伴低氧血症中央气道狭窄  

Noninvasive ventilation combined with interventional bronchoscopy in the treatment of hypoxemia patients complicated with central airway stenosis

作　　者：陈小可[1] 周一平[1] 喻海琼[1] 夏利萍[1] 刘慧[1] 刘念[1] 李艾芬[1] 林海容[1] 

机构地区：[1]广东医学院附属深圳福田区人民医院呼吸科,广东深圳518033

出　　处：《临床肺科杂志》2015年第4期644-646,共3页Journal of Clinical Pulmonary Medicine

基　　金：深圳市科技研发资金基础研究项目(No JCYJ20140416094256887)

摘　　要：目的探讨无创通气辅助内镜治疗伴低氧血症中央气道狭窄的效果和安全性。方法伴低氧血症中央气道狭窄拟行支气管镜介入治疗患者10例,含恶性肿瘤5例,气管-支气管结核4例,气管切开后气管狭窄1例。患者用口鼻面罩接三通延长管再接无创呼吸机(迈柯唯SERVO呼吸机)。静脉注入地佐辛、咪达唑仑镇静镇痛,支气管镜自三通延长管经鼻或口,行各种介入治疗。结果 10例患者均顺利完成介入治疗,包括冷冻治疗8例次,氩气刀6例次,球囊扩张5例次,高频电刀2例次。操作时长58.4±16.4 min,气道狭窄程度、血氧分压、气促评分术后均显著改善。术中1例患者因氩气刀治疗暂停高浓度吸氧出现一过性血氧饱和度降至85%,经暂停氩气刀治疗,纯氧通气2 min后升至90%以上。治疗未引起严重并发症。100%患者出现顺行遗忘,并愿意接受下次治疗。结论镇静镇痛下,无创通气辅助内镜治疗伴低氧血症中央气道狭窄安全有效,患者舒适度高,有一定的临床推广价值。Objective To evaluate the effect and safety of noninvasive ventilation combined with interventional bronchoscopy in the treatment of hypoxemia patients complicated with central airway stenosis. Methods 10 patients with hypoxemia central airway stensis undergoing interventional bronchoscopy,including 5 cases of malignant tumor,4 cases of bronchial tuberculosis,1 case of tracheal stenosis caused by tracheotomy. Patients covered with full mask and then connected with noninvasive ventilator（ MAQUET Servo）. They were given intravenous injection of dezocine and midazolam for sedation and analgesia. Results All cases were treated successfully,including cryotherapy in 8 cases,argon plasma coagulation in 6 cases,balloon dilatation in 5 cases,2 cases of electrocautery. The procedure time was 58. 4 ± 16. 4 minutes. The degree of airway stenosis and partial pressure of arterial oxygen were significantly improved after operation. During the argon plasma coagulation in one patient,the Sp O2 dropped to 85% as the fraction of inspired oxygen lowered from 1. 0 to 0. 30,which was transient and not life-threatening. The treatment did not cause serious complications. Sedation produced anterograde amnesia in all patients who expressed an intent to return for repeated interventional bronchoscopy if needed. Conclusion With the sedation and analgesia,noninvasive ventilation combined with interventional bronchoscopy is safe and effective in the treatment of hypoxemia patients complicated with central airway stenosis.

关 键 词：无创正压辅助通气 镇静镇痛 支气管镜 介入治疗 中央气道狭窄 

分 类 号：R56[医药卫生—呼吸系统]