纤维支气管镜直视下有创机械通气中置入金属支架治疗恶性肿瘤致中心气道狭窄的临床应用  

Application of self-expandable metallic stent implantation through flexible fiberoptic bronchoscope under mechanical ventilation in patients with malignant central airway stenosis

作　　者：周正[1] 王林梅[1] 韩校鹏 王艳丽[1] 刘剑波[1] 邵润霞[1] 齐景宪[1] Zheng Zhou;Lin-mei Wang;Xiao-peng Han;Yan-li Wang;Jian-bo Liu;Run-xia Shao;Jing-xian Qi(Department of Pulmonary and Critical Care Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症医学科,河南郑州450003

出　　处：《中国内镜杂志》2020年第4期14-18,共5页China Journal of Endoscopy

摘　　要：目的探讨在机械通气情况下置入气道支架解除恶性肿瘤引起中心气道狭窄的可行性和安全性。方法在机械通气下,将纤维支气管镜和气管插管并行进入气道,在纤维支气管镜直视下经气管插管置入金属气道支架。结果11例恶性肿瘤引起的中心气道狭窄在机械通气下置入金属气道支架11枚,狭窄解除、呼吸机撤离、操作顺利,缺氧症状缓解。改良英国医学研究学会呼吸困难指数(mMRC)评分、气道压和气道狭窄均改善明显,与支架置入前比较,差异均有统计学意义(P<0.05);动脉血气分析中,动脉血氧分压(PaO2)和动脉血氧饱和度(SaO2)升高,动脉血二氧化碳分压(PaCO2)降低,与支架置入前比较,差异均有统计学意义(P<0.05)。结论在纤维支气管镜直视下,将支架推送器经气管插管置入气道支架治疗中心气道狭窄是可行的、安全的,且近期疗效显著。Objective To investigate the practicality and safety of flexible fiberoptic bronchoscope-assisted placement of airway stents to relieve central airway stenosis caused by malignant tumour under mechanical ventilation.Methods The fiberoptic bronchoscope and the tracheal tube were inserted into the airway in parallel under mechanical ventilation,and the metal airway stent was placed in through the tracheal tube under the guidance of fiberoptic bronchoscope.Results 11 patients with malignant airway stenosis received this procedure.After stent placement,central airway stenosis was relieved,and the symptoms of hypoxia were alleviated in all of the patients.The operation was smooth,and all the patients were weaned from mechanical ventilation.After stents were implanted,dyspnea scores,airway stenosis and airway pressure were improved significantly(P<0.05);PaO2 and SaO2 were improved significantly(P<0.05),PaCO2 was declined significantly(P<0.05).Conclusion Fiberoptic bronchoscope-assisted metal stent implantation is practical,safe,and shows good short-term clinical outcome for the treatment of malignant severe airway stenosis.

关 键 词：恶性肿瘤 中心气道狭窄 机械通气 纤维支气管镜 金属支架 

分 类 号：R562.2[医药卫生—呼吸系统] R73[医药卫生—内科学]