摘要
目的回顾性探讨纤维支气管镜(纤支镜)在重症监护室(ICU)老年危重医院获得性肺炎(HAP)患者检查和救治的效果、安全性、必要性及操作中的关键问题。方法对42例入住ICU明确诊断为HAP的60岁以上的老年危重患者,按是否采用纤支镜干预治疗分为纤支镜治疗组(22例)和常规治疗组(20例),比较两组ICU停留时间、纤支镜使用前后动脉血气分析变化、HAP临床进展率及病死率等的变化。结果与常规治疗组比较,纤支镜治疗组ICU停留时间([11±4)︰(16±4)]d、机械通气时间([9±5)︰(13±5)]d均明显缩短(P<0.05)、HAP病死率(13.6%︰40.0%)明显降低(P<0.05);纤支镜治疗后动脉血氧分压(PaO2)显著升高、呼吸频率显著下降好转,与治疗前比较差异均有显著性(P<0.05)、动脉血二氧化碳分压(PaCO2)及pH值均较对照组同一时间显著好转,差异均有显著性(均P<0.05)。同时老年危重患者因气管插管、镇静剂应用、鼻饲饮食不当及制酸剂使用不当等原因致误吸的风险增加,成为HAP感染的主要原因,对于此类患者采用床旁纤支镜吸引排痰成为一种必要的治疗手段,疗效确定。结论纤支镜是老年危重医院获得性肺炎(HAP)患者治疗中安全有效的方法,值得推广。
【Objective】To retrospectively evaluate the effective,security,necessity and operation of the key of the application of bronchofibroscopy （BFS） in the examination and therapy among these critical elderly patients with hospital acquired pneumonia.【Methods】42 critical elderly patients more than 60 with HAP were divided into two groups depending on whether the BFS was undertaken （group A,n =22） or not （group B,n =20）,the clinical therapeutic effects were evaluated by comparing the difference of intensive care unit （ICU） resident,the analysis of artery blood gas before and after BFS,the clinical morbidity of HAP.【Results】The time of ICU resident [（11±4） d vs （16± 4） d] and mechanical ventilation [（9±5） d vs （13±5） d] in group A were shorter,and the HAP mortality rate （13.6% vs 40.0%） decreased significantly in group A;arterial partial pressure of oxygen （PaO2）,arterial partial pressure of carbon dioxide （PaCO2）,arterial oxygen saturation （SaO2）,oxygenation index （PaO2/FiO2） were much better after treatment than those before BFS （P 0.05）.Also the aspiration risk increased by the improper use of intubations,sedative,nasal feeding,antacids and so on led to the HAP infection,and that the bedside fiberoptic endoscopic suction was a necessary treatment to these patients.【Conclusion】BFS is a safe and effective treatment for critical elderly patients with hospital acquired pneumonia and is worth to recommend.
出处
《中国内镜杂志》
CSCD
北大核心
2010年第11期1125-1128,共4页
China Journal of Endoscopy
关键词
纤维支气管镜
ICU
老年
医院获得性肺炎
bronchofibroscopy
ICU
the elderly patients with hospital acquired pneumonia
