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目的了解纤维支气管镜(FOB)经气管导管旁进入方法(旁路法)及支气管灌洗术(BL)对接受经人工气道机械通气(ETMV)支持呼吸衰竭患者呼吸力学的影响。方法21例经气管造口接受ETMV辅助通气的呼吸衰竭患者,采用自身前后对照的研究方法,在生命体征及血流动力学稳定的情况下,不中断ETMV,FOB先后采用经气管导管内法和旁路法进入检查及BL。两次操作间隔时间30 min。同时监测患者的气道峰压(PIP)、平台压(Pplat)、呼气峰流速(PEF)、吸气阻力(RI)、呼气阻力(RE)及动态顺应性(Cdyn),并应用呼气阻断法测定内源性PEEP(PEEPi)。观察旁路法FOB检查及BL前后动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)、血氧饱和度(SpO2)、心率(HR)与血压(BP)的变化。结果旁路法与导管内法相比,PIP(22.8±3.6)cmH2O、RI(18.5±4.1)cmH2O/(L·s)与RE(21.0±3.6)cmH2O/(L·s)显著降低,而PEF(31.2±3.4)L/min显著升高(P<0.05)。所有患者FOB旁路法进入检查及BL后2h与术前相比,PIP(18.7±2.6)cmH2O、PEEPi(1.0±0.3)cmH2O、RI(11.5±2.8)cmH2O/(L·s)、RE(16.5±4.5)cmH2O/(L·s)、PaCO2(58.1±4.3)mmHg显著降低(P<0.05),PEF(39.5±5.2)L/min、Cdyn(49.3±3.3)ml/cmH2O、PaO2(74.5±4.3)mmHg、SpO2(96.7±2.4)%显著升高(P<0.05),而HR,BP则差?
Objective To investigate the effect of fibrobronchoscope (FOB) bypassing tracheal approach (bypass) and bronchoalveolar lavage (BL) on respiratory mechanics in patients with respiratory failure undergoing artificial airway mechanical ventilation (ETMV). Methods Twenty-one patients with respiratory failure who received endotracheal ETMV assisted tracheal stomatology were enrolled in this study. Before and after ETMV was used in the control of vital signs and hemodynamics, FOB was treated with endotracheal tube method and Bypass method into the inspection and BL. The interval between two operations is 30 min. PIP, Pplat, PEF, RI, RE and Cdyn were monitored at the same time. Gas Cholesterol Blockade for Endogenous PEEPi. To observe the changes of FOB examination by bypass method and PaO2 and PaCO2, SpO2, HR and BP before and after BL. Results Bypass method significantly reduced PIP (22.8 ± 3.6) cmH2O, RI (18.5 ± 4.1) cmH2O / (L · s) and RE (21.0 ± 3.6) cmH2O / (L · s) (31.2 ± 3.4) L / min (P <0.05). All patients underwent FOB by-pass method and were examined at 2h after BL and PIP (18.7 ± 2.6) cmH2O and PEEPi (1.0 ± 0.3) cmH2O and RI (11.5 ± 2.8) cmH2O / (L · s) (P <0.05), PEF (39.5 ± 5.2) L / min, Cdyn (49.3 ± 3.3) ml / cmH2O and PaO2 (74.5 ± 4.5) cmH2O / ± 4.3) mmHg, SpO2 (96.7 ± 2.4)% were significantly higher (P <0.05), while HR, BP was poor?