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目的探讨早期纤维支气管镜(纤支镜)引导经鼻气管插管急诊抢救重型颅脑损伤并误吸的临床应用价值。方法 160例重型颅脑损伤并误吸的患者于入急诊抢救室后立即实施纤支镜引导经鼻气管插管并清除误吸物及行支气管肺泡灌洗术,30 min内完成操作。观察患者操作前后血氧饱和度、吸氧浓度(Fi O2)、氧合指数(Pa O2/Fi O2)、吸气峰压(PIP)变化。结果 160例患者操作过程均顺利,均未发生严重并发症。术后较术前比较Fi O2、PIP显著降低,血氧饱和度、氧合指数明显好转。经治疗无一例出现吸入性肺炎及阻塞性肺不张。结论早期纤支镜引导经鼻气管插管抢救重型颅脑损伤并误吸,对防止窒息、吸入性肺炎及阻塞性肺不张的发生,预防和纠正低氧血症,保障脑供氧,提高救治成功率及改善预后有重要价值,并具有良好的安全性,值得临床推广应用。
Objective To investigate the clinical value of early bronchofibroscopy (bronchofibroscopy) guided emergency treatment of nasal tracheal intubation to rescue severe craniocerebral injury and aspiration. Methods 160 patients with severe traumatic brain injury and aspiration were admitted to emergency room immediately after the implementation of fiberoptic bronchial catheterization and removal of aspiration and bronchial alveolar lavage, 30min to complete the operation. Oxygen saturation (Fi O2), oxygenation index (Pa O2 / Fi O2) and peak inspiratory pressure (PIP) were measured before and after operation. Results The operation of 160 patients were smooth, no serious complications occurred. Compared with preoperative FiO, PIP significantly decreased, oxygen saturation, oxygenation index significantly improved. No case of aspiration pneumonia and obstructive atelectasis after treatment. Conclusion Early bronchoscopy guided tracheal intubation to rescue severe craniocerebral injury and aspiration, to prevent asphyxia, aspiration pneumonia and obstructive atelectasis, prevent and correct hypoxemia, protect brain oxygen supply, improve Treatment success rate and improve the prognosis of great value, and has good safety, it is worth clinical application.