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目的探讨纤支镜引导下经鼻气管插管有创与无创序贯抢救Ⅱ型呼吸衰竭的临床价值。方法对我院2005年4月至2006年8月救治的Ⅱ型呼吸衰竭(重症)60例患者资料作回顾性分析,对纤支镜引导经鼻气管插管与经口喉镜明视插管有创、无创序贯进行机械通气各自的成功率、留管时间、气管切开率、拔管率及患者预后情况进行比较。结果置管时间经鼻插管组9.4±5.5 d,经口插管3.5±1.4 d;气管切开率:经鼻插管组6.7%,经口插管组46.7%;拔管率:经鼻插管组93.3%,经口插管组40.0%,(P 均<0.01),差异均有显著性。结论经口气管插管或气管切开的缺点是患者往往不能耐受或接受;纤支镜引导下经鼻气管插管有创、无创序贯治疗抢救Ⅱ型呼吸衰竭,患者耐受性好,留管时间长,拔管率高,同时可避免或减少气管切开率,具有快速、准确、安全,能尽早撤机,减少呼吸机相关性肺炎等并发症之优点,值得临床推广。
Objective To investigate the clinical value of invasive and noninvasive sequential rescue Ⅱ respiratory failure with nasal endotracheal intubation guided by fiberoptic bronchoscopy. Methods The data of 60 patients with type Ⅱ respiratory failure (severe) who were treated in our hospital from April 2005 to August 2006 were retrospectively analyzed. The patients undergoing bronchofibroscope tracheal intubation and oral throat mirror Invasive, noninvasive sequential success rate of mechanical ventilation, duration of stay, tracheotomy rate, extubation rate and prognosis of patients were compared. Results The catheterization time was 9.4 ± 5.5 days in nasal intubation group and 3.5 ± 1.4 days in oral intubation group. Tracheotomy rate was 6.7% in nasal intubation group and 46.7% in oral intubation group. Extubation rate: 93.3% in intubation group and 40.0% in oral intubation group (all P <0.01), the differences were significant. Conclusion The disadvantage of orotracheal intubation or tracheotomy is that patients often can not tolerate or accept; bronchoscopy guided by nasotracheal intubation invasive, noninvasive sequential treatment of type Ⅱ respiratory failure, the patient is well tolerated, Long tube stay, extubation rate, at the same time to avoid or reduce the tracheostomy rate, with rapid, accurate, safe, as soon as possible to weaning, to reduce the complications of ventilator-associated pneumonia and other merits, is worth clinical promotion.