纤维支气管镜在接受静脉-静脉体外膜肺氧合治疗患者中的应用  

Application of fiberoptic bronchoscopy in patients undergoing veno-venous extracorporeal membrane oxygenation therapy

作　　者：赵雪 高翔[2] 张勇 张明 刘晓宇 朱玉琴 李鑫燕 ZHAO Xue;GAO Xiang;ZHANG Yong;ZHANG Ming;LIU Xiaoyu;ZHU Yuqin;LI Xinyan(School of Clinical Medicine,Shandong Second Medical University,Weifang,Shandong,261042,China;Department of Critical Care Medicine,Weifang Peoples Hospital,Shandong Second Medical University;Department of Critical Care Medicine,Affiliated Hospital of Shandong Second Medical University;Department of Critical Care Medicine,the Peoples Hospital of the Qiandongnan)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261042 [2]山东第二医科大学第一附属医院(潍坊市人民医院)重症医学科 [3]山东第二医科大学附属医院重症医学科 [4]黔东南州人民医院重症医学科

出　　处：《临床急诊杂志》2025年第2期107-113,共7页Journal of Clinical Emergency

基　　金：山东省中医药科技项目(No:M-2022239)。

摘　　要：目的:探讨纤维支气管镜在接受静脉-静脉体外膜肺氧合(veno-venous extracorporeal membrane oxygenation,VV-ECMO)治疗患者中的应用价值。方法:回顾性分析2022年4月—2024年5月山东第二医科大学附属医院及潍坊市人民医院重症医学科收治的99例接受VV-ECMO治疗成人患者的临床资料,其中6例资料不完整,93例被纳入分析。按有无应用纤维支气管镜分为纤支镜组(62例)和对照组(31例),进一步按首次应用时间将纤支镜组分为早期组(34例)和晚期组(28例)两亚组。比较各组患者基线资料、肺泡灌洗液及痰液的病原学培养结果、ICU治疗时间、有创机械通气时间、VV-ECMO治疗时间、并发症、28 d死亡率指标的差异;绘制Kaplan-Meier生存曲线,分析各组28 d累积生存率。结果:纤支镜组和对照组患者的基线资料及并发症发生率差异无统计学意义(P>0.05);纤支镜组的VV-ECMO治疗时间、有创机械通气时间及ICU住院时间显著长于对照组(P<0.05),28 d死亡率显著低于对照组(P<0.05);纤支镜组中肺泡灌洗液病原学培养阳性率显著高于痰液(P<0.05);Kaplan-Meier生存曲线显示,纤支镜组28 d累积生存率显著高于对照组(P<0.05)。早期组VV-ECMO治疗时间、有创机械通气时间、ICU治疗时间显著短于晚期组(P<0.05),但两组并发症发生率和28 d死亡率差异无统计学意义(P>0.05);Kaplan-Meier生存曲线显示,早期组和晚期组28 d累积生存率比较,差异无统计学意义(P>0.05)。结论:纤维支气管镜在VV-ECMO患者中的应用显著提高了生存率和致病菌检出率,具有较高安全性;早期应用纤维支气管镜可明显缩短VV-ECMO治疗、有创机械通气及ICU住院时间,值得临床推广。Objective To investigate the application value of fiberoptic bronchoscopy in patients undergoing veno-venous extracorporeal membrane oxygenation(VV-ECMO).Methods The clinical data of 99 adult patients treated with VV-ECMO treated in the Affiliated Hospital of Shandong Second Medical University and the Department of Intensive Care Medicine of Weifang People's Hospital from April 2022 to May 2024 were retrospectively analyzed.The data of 6 cases were incomplete,and 93 cases were included in the analysis.The fiberoptic group was divided into a fiberscope group(62 cases)and a control group(31 cases)according to the presence or absence of fiberscope application.And the fiberoptic bronchoscopy group was further divided into an early group(34 cases)and a late group(28 cases)according to the time of the first application.Difference in baseline data,etiological culture results of alveolar lavage fluid and sputum,ICU treatment time,invasive mechanical ventilation time,VV-ECMO treatment time,complications and 28 d mortality indexes were compared among all groups.Kaplan-Meier survival curves were plotted to analyze the 28-day cumulative survival rates of each group.Results There was no significant difference in baseline data and incidence of complications between bronchoscopy group and control group(P>0.05).The duration of VV-ECMO treatment,invasive mechanical ventilation and ICU stay in the bronchoscopy group were significantly longer than those in the control group(P<0.05),and the 28 d mortality rate was significantly lower than that in the control group(P<0.05).The positive rate of pathogen culture in alveolar lavage fluid was significantly higher than that in sputum(P<0.05).Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of fiberoptic bronchoscopy group was significantly higher than that of the control group(P<0.05).The treatment time of VV-ECMO,invasive mechanical ventilation time and ICU treatment time in the early group were significantly shorter than those in the late group(P<0.05),but the

关 键 词：纤维支气管镜 静脉-静脉体外膜肺氧合 有创机械通气 早期应用 安全性 

分 类 号：R459.7[医药卫生—急诊医学]