摘要:目的：探討纖支鏡經(jīng)口引導(dǎo)氣管插管在慢阻肺合并重度呼吸衰竭救治中的臨床應(yīng)用價(jià)值。方法：237例慢阻肺合并重度呼吸衰竭患者,隨機(jī)分為纖支鏡經(jīng)口引導(dǎo)氣管插管組(纖支鏡組)125例和喉鏡經(jīng)口引導(dǎo)氣管插管組(喉鏡組)112例,分別在纖支鏡和喉鏡引導(dǎo)下按常規(guī)進(jìn)行氣管插管術(shù)。結(jié)果：纖支鏡組和喉鏡組一次獲得插管成功率分別為984%和920%(P＜005),平均插管時(shí)間分別為（613±391） min 和（926±415） min(P＜005)。纖支鏡組有5例患者出現(xiàn)咽喉部少量出血,并發(fā)癥發(fā)生率為40%;喉鏡組共有12例發(fā)生并發(fā)癥,并發(fā)癥發(fā)生率為107%(P＜005),其中齒、舌、咽或喉部損傷6例,反射性嘔吐致誤吸2例,單側(cè)肺通氣1例,插入食管2例,心跳呼吸驟停1例。結(jié)論：纖支鏡經(jīng)口引導(dǎo)氣管插管在慢阻肺合并重度呼吸衰竭救治中是一種簡(jiǎn)便快速、成功率高和并發(fā)癥少的有效方法,值得臨床推廣應(yīng)用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
目的 觀察VOX［Volume-OXygenation, SpO2/（FiO2*VT）］指數(shù)對(duì)Ⅰ型呼吸衰竭患者早期無(wú)創(chuàng)正壓通氣（non-invasive positive pressure ventilation，NIPPV）治療效果的預(yù)測(cè)價(jià)值。方法 回顧分析2019年9月—2022年9月重癥醫(yī)學(xué)科（ICU）收治的Ⅰ型呼吸衰竭早期NIPPV治療患者，依據(jù)2小時(shí)NIPPV VOX指數(shù)-氣管插管約登指數(shù)分組，VOX指數(shù)>20.95為觀察組（n=69），VOX指數(shù)≤20.95為對(duì)照組（n=64）。收集患者基線數(shù)據(jù)及NIPPV 2小時(shí)、12小時(shí)、24小時(shí)動(dòng)脈血?dú)庵?，統(tǒng)計(jì)NIPPV結(jié)局、插管情況、NIPPV時(shí)間、住院時(shí)間、病死率等。結(jié)果 兩組患者基線資料中呼吸頻率有統(tǒng)計(jì)學(xué)差異，其他資料差異無(wú)統(tǒng)計(jì)學(xué)意義。與對(duì)照組比較，觀察組NIPPV 2小時(shí)氧合指數(shù)（P/F）［（182.5±66.1）比（144.1±63.6）mm Hg，P<0.05］ 上升更明顯，12小時(shí)內(nèi)NIPPV失敗插管率（4.35%比32.81%，P<0.05）更低， 24小時(shí)內(nèi)NIPPV成功撤機(jī)率（40.58%比0%，P<0.05）更高、NIPPV失敗插管率（4.35%比46.88%，P<0.05）更低。治療結(jié)局比較，觀察組插管率（4.35%比67.19%，P<0.05）更低。以2小時(shí)NIPPV VOX指數(shù)臨界值20.95作為NIPPV早期失敗的預(yù)測(cè)指標(biāo)，敏感性為74.7%，特異性為93.5%。結(jié)論 對(duì)Ⅰ型呼吸衰竭早期NIPPV治療患者，以NIPPV治療2小時(shí)VOX指數(shù)>20.95作為評(píng)價(jià)指標(biāo)，能夠較好的預(yù)測(cè)低氧血癥改善及NIPPV失敗氣管插管風(fēng)險(xiǎn)，具有較好的臨床價(jià)值。