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目的探索呼吸机相关性气管-支气管损伤(VAT)的发生率、临床表现、时限性及发病原因。方法收集RICU呼吸机应用前无明显气管-支气管损伤而后证实有损伤的病例32例,在1、2、3、4、5d后进行纤支镜检查,根据时间段记录镜下改变,临床表现及病原体检查结果。结果 VAT随机械通气的时间延长而加重。32例患者均有发红出血,25例有糜烂,27例患者可见结痂,假膜形成的有7例,形成活瓣堵塞管口的有3例;患者以发热和气喘为主,50%患者可培养出病原体。11例患者可见气道压升高,分钟通气量减少。23例强制通气时间延长,脱机困难。12例死亡。结论呼吸机相关性气管-支气管损伤的发病率和死亡率均接近30%,而多数患者发展为呼吸机相关性肺炎(VAP)。
Objective To explore the incidence of ventilator-associated tracheal-bronchial injury (VAT), clinical manifestations, timeliness and causes of the disease. Methods Thirty-two cases of traumatic-bronchial injury without evidence of tracheal-bronchial injury before RICU ventilator application were collected. Bronchoscopy was performed after 1, 2, 3, 4, and 5 days. Changes were recorded according to time course, and clinical manifestations Pathogen test results. As a result, the duration of VAT increased with the duration of mechanical ventilation. 32 patients had red bleeding, 25 cases of erosion, 27 patients showed scab, the formation of pseudomembranous in 7 cases, the formation of valve plugging orifice in 3 cases; patients with fever and asthma, 50% Patients can develop pathogens. Eleven patients showed elevated airway pressure and decreased minute ventilation. 23 cases of forced ventilation extended, off-line difficulties. 12 died. Conclusions The incidence and mortality of ventilator-associated tracheal-bronchial injury are both close to 30%, whereas most patients develop ventilator-associated pneumonia (VAP).