早期纤支镜引导经鼻气管插管急诊抢救重型颅脑损伤并误吸的体会  

Experience of early bronchofiberscopic nasotracheal intubation in emergency rescue of severe craniocerebral injury complicated with aspiration

作　　者：吴燕生[1] 石秀华[1] 康德[1] 

机构地区：[1]解放军第175医院(厦门大学附属东南医院)急诊科,363000

出　　处：《中国实用医药》2015年第31期28-30,共3页China Practical Medicine

摘　　要：目的探讨早期纤维支气管镜(纤支镜)引导经鼻气管插管急诊抢救重型颅脑损伤并误吸的临床应用价值。方法 160例重型颅脑损伤并误吸的患者于入急诊抢救室后立即实施纤支镜引导经鼻气管插管并清除误吸物及行支气管肺泡灌洗术,30 min内完成操作。观察患者操作前后血氧饱和度、吸氧浓度(Fi O2)、氧合指数(Pa O2/Fi O2)、吸气峰压(PIP)变化。结果 160例患者操作过程均顺利,均未发生严重并发症。术后较术前比较Fi O2、PIP显著降低,血氧饱和度、氧合指数明显好转。经治疗无一例出现吸入性肺炎及阻塞性肺不张。结论早期纤支镜引导经鼻气管插管抢救重型颅脑损伤并误吸,对防止窒息、吸入性肺炎及阻塞性肺不张的发生,预防和纠正低氧血症,保障脑供氧,提高救治成功率及改善预后有重要价值,并具有良好的安全性,值得临床推广应用。Objective To investigate clinical application value of early bronchofiberscopic nasotracheal intubation in emergency rescue of severe craniocerebral injury complicated with aspiration.Methods A total of 160 patients with severe craniocerebral injury complicated with aspiration received bronchofiberscopic nasotracheal intubation, aspiration content clear and bronchoalveolar lavage in 30 min after emergency rescue. Changes of oxyhemoglobin saturation, fraction of inspiration O2 （FiO2）, oxygenation index （PaO2/FiO2）, and peak inspiratory pressure （PIP） were observed before and after treatment in those patients.Results All the 160 patients received successful treatment, without any severe complications. FiO2 and PIP were obviously reduced, and oxyhemoglobin saturation and oxygenation index were significantly improved after treatment. There was none aspiration pneumonia or obstructive atelectasis case after treatment.Conclusion Early bronchofiberscopic nasotracheal intubation in emergency rescue of severe craniocerebral injury complicated with aspiration contains important value for preventing occurrence of asphyxia, aspiration pneumonia and obstructive atelectasis, correcting hyoxemia, ensuring cerebral oxygen supply, improving success rate and prognosis. This method has good safety, and it is worthy of clinical promotion and application.

关 键 词：纤维支气管镜 经鼻气管插管 急诊抢救 重型颅脑损伤 误吸 

分 类 号：R651.15[医药卫生—外科学]