俯卧位通气联合纤维支气管镜治疗昏迷并发肺不张患者的疗效

doi:10.3969/j.issn.1004-583X.2023.05.006

摘要/Abstract

摘要：

目的探讨俯卧位通气联合纤维支气管镜(纤支镜)治疗昏迷患者并发肺不张的效果。方法分析2021年6月至2022年5月在我院外科重症监护室因重型颅脑损伤、自发性脑出血、颅内动脉瘤破裂出血术后住院,原发病趋于稳定,由于肺部感染、肺不张导致的脱机困难的患者,共36例。观察组18例,常规治疗加俯卧位通气治疗联合纤支镜治疗;对照组18例,常规治疗加纤支镜治疗。收集两组治疗前后的影像学资料(胸部CT/DR)、动脉血气、呼吸机参数、机械通气时间、抗生素的使用情况、ICU入住时间、并发症等。结果观察组治疗后肺不张均有改善,氧合指数明显提高,其中有6例出现不同程度的压疮,但最终愈合良好,无其他严重并发症发生。对照组中有12例肺不张得到改善,氧合指数提高。观察组和对照组肺不张的改善率分别为100%和67%,差异有统计学意义,提示俯卧位通气联合纤支镜治疗较常规治疗对肺不张更有益处。结论俯卧位通气联合纤支镜治疗,可作为昏迷并肺不张患者的一种有效治疗方式。

关键词: 肺不张, 昏迷, 俯卧位, 支气管镜

Abstract:

Objective To investigate the therapeutic effect of prone position ventilation combined with fiberoptic bronchoscopy on coma patients with atelectasis. Methods A total of 36 patients hospitalized in the surgical intensive care unit (ICU) of our hospital from June 2021 to May 2022 due to severe brain injury, spontaneous cerebral hemorrhage, intracranial aneurysm rupture and hemorrhage who were unable to withdraw the ventilator due to pulmonary infection and atelectasis were retrospectively analyzed. Their primary diseases tended to be stable. They were randomly divided into observation group and control group, with 18 in each group. Patients in observation group were managed by conventional treatment combined with prone position ventilation and fiberoptic bronchoscopy, and those in control group were managed by conventional treatment combined with fiberoptic bronchoscopy. Imaging data (chest computed tomography [CT]/digital radiography [DR]), arterial blood gas test data, ventilator parameters, mechanical ventilation time, use of antibiotics, ICU hospitalization time, and complications before and after treatment in both groups were collected. Results After treatment, the atelectasis of all patients in observation group was improved, with the significantly increased oxygenation index. Among them, six cases had pressure sores of varying degrees, and eventually cured. Other serious complications in observation group were not reported. In the control group, twelve patients had improved atelectasis and increased oxygenation index. The improvement rate of atelectasis in the observation group was significantly higher than that in the control group (100% vs 67%), suggesting that the treatment of prone position ventilation combined with fiberoptic bronchoscopy was more beneficial to atelectasis than conventional treatment. Conclusion Prone position ventilation combined with fiberoptic bronchoscopy is an effective treatment to coma patients with atelectasis.

Key words: atelectasis, coma, prone position, bronchoscopy

中图分类号:

R563.4

冯阳, 王向蒙. 俯卧位通气联合纤维支气管镜治疗昏迷并发肺不张患者的疗效[J]. 临床荟萃, 2023, 38(5): 423-427.

Feng Yang, Wang Xiangmeng. Effect of prone position ventilation combined with fiberoptic bronchoscopy in the treatment of coma patients with atelectasis[J]. Clinical Focus, 2023, 38(5): 423-427.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.05.006

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I5/423

图/表 6

参考文献 26

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组别	例数	性别 (男/女)	年龄 (岁)	APACHE Ⅱ 评分(分)	GCS评分 (分)
观察组	18	13/5	59.94±12.64	19.00±3.33	6.01±1.09
对照组	18	12/6	57.83±13.36	20.33±3.69	5.89±1.49
χ²/t值		2.778	0.487	-1.138	0.256
P值		0.067	0.977	0.435	0.345

组别	例数	性别 (男/女)	年龄 (岁)	APACHE Ⅱ 评分(分)	GCS评分 (分)
观察组	18	13/5	59.94±12.64	19.00±3.33	6.01±1.09
对照组	18	12/6	57.83±13.36	20.33±3.69	5.89±1.49
χ²/t值		2.778	0.487	-1.138	0.256
P值		0.067	0.977	0.435	0.345

组别	例数	氧合指数(mmHg)
组别	例数	治疗前	治疗后
观察组	18	110.25±17.15	205.73±26.73^*
对照组	18	111.48±16.68	187.71±11.81^*
t值		-0.315	2.618
P值		0.755	0.013

组别	例数	氧合指数(mmHg)
组别	例数	治疗前	治疗后
观察组	18	110.25±17.15	205.73±26.73^*
对照组	18	111.48±16.68	187.71±11.81^*
t值		-0.315	2.618
P值		0.755	0.013

组别	例数	PaO₂(mmHg)
组别	例数	治疗前	治疗后
观察组	18	59.61±6.24	92.44±7.16^*
对照组	18	58.94±6.84	76.44±6.71^*
t值		0.507	6.777
P值		0.616	0.000