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目的:探讨成人危重呼吸道阻塞的临床诊断及治疗方案。方法:1995年1月~2006年12月我科收治86例成人危重呼吸道阻塞,采用快速诊断和及时解除呼吸困难的临床处理方法,分析应用该方法的效果。结果:86例危重患者中,炎症性疾病34例,占39.5%;肿瘤性疾病32例,占37.2%;外伤性疾病9例,占10.5%。其他还有喉痉挛3例,喉狭窄6例,双侧声带麻痹2例,鼻咽癌放疗后大出血误吸窒息1例。喉和气管阻塞分别为60例和13例,占69.8%和15.1%。采用气管切开和气管插管分别为46例和4例,占53.5%和4.7%。只采用内科治疗缓解呼吸困难26例。86例患者均于2h内确诊并解除重度呼吸道阻塞。发生严重并发症者14例,发生率为16.3%;手术并发症6例,发生率为6.9%。死亡1例。结论:成人危重呼吸道阻塞的病因复杂,阻塞部位和性质多变,采取快速诊断、及时解除呼吸道阻塞的诊疗方案,是确保疗效的关键。
Objective: To investigate the clinical diagnosis and treatment of critically ill adult airway obstruction. Methods: From January 1995 to December 2006, 86 cases of critically ill obstructive airway obstruction were admitted in our department. The clinical treatment of rapid diagnosis and timely relief of dyspnea were analyzed, and the effect of this method was analyzed. Results: Of 86 critically ill patients, 34 were inflammatory diseases, accounting for 39.5%; 32 were neoplastic diseases, accounting for 37.2%; 9 were traumatic diseases, accounting for 10.5%. There are other laryngospasm in 3 cases, laryngeal stenosis in 6 cases, bilateral vocal cord paralysis in 2 cases, nasopharyngeal carcinoma after radiotherapy aspiration hemorrhage asphyxia in 1 case. Throat and tracheal obstruction were 60 and 13 cases, accounting for 69.8% and 15.1%. Tracheostomy and endotracheal intubation were 46 cases and 4 cases, accounting for 53.5% and 4.7%. Only medical treatment to relieve dyspnea in 26 cases. 86 patients were diagnosed within 2h and relieve severe airway obstruction. 14 cases of serious complications, the incidence was 16.3%; surgical complications in 6 cases, the incidence was 6.9%. 1 case of death. Conclusion: The causes of critically ill obstructive airway obstruction in adults are complex and the site and nature of obstruction change. Taking the diagnosis and treatment programs of rapid diagnosis and timely removal of airway obstruction is the key to ensure curative effect.