评价重症监护病房床旁纤维支气管镜术在危重患者气道管理中的应用价值。

收集2008年1月至2015年12月丽水市中心医院重症监护病房956例行床旁纤维支气管镜术危重患者的临床资料。总结其入镜途径、操作目的、治疗疗效、痰培养结果及并发症的发生情况。

956例危重患者行纤维支气管镜术共1 321次，929例经人工气道入镜，25例经鼻腔入镜，2例经口入镜。操作目的以清除分泌物和治疗肺不张为主，占95.08%（909/956），852例肺部感染患者以抗生素联合行床旁纤维支气管镜术清除分泌物1 126次，术后患者症状、体征及实验室指标均得到不同程度改善，总有效率89.12%（852/956）；57例肺不张患者行床旁纤维支气管镜术直视下吸引、灌洗142次，有效率91.23%（52/57）。同时，镜下留取分泌物送培养437例，培养阳性289例（阳性率66.13%）。并发症主要为低氧血症，心律失常，术后气道出血，无严重不良反应。

纤维支气管镜术在危重患者气道管理中有较好的诊断和治疗价值，值得进一步推广应用。

To evaluate the application value of bedside fiberoptic bronchoscopy (BFB) on airway management in intensive care unit (ICU) patients.

The clinical data of 956 ICU patients who underwent BFB from January 2008 to December 2015 in the Central Hospital of Lishui City were enrolled in this study. The route of BFB entrance, destination, therapeutic effect, sputum culture and complication were summarized and recorded.

Totally 956 cases of critically ill patients were treated with BFB of 1 321 times, and 929 cases were treated by artificial airway, 25 cases by nasal endoscope, and 2 cases by endoscopy. Operating purpose was given priority to the secretion clearance and atelectasis treatment in 95.08% patients (909/956). Eight hundred and fifty-two patients (89.12%) with pulmonary infection were given antibiotics combined with 1 126 times of BFB to remove secretions, and the symptoms, signs and laboratory indicators were all improved postoperatively. Fifty-seven atelectasis patients underwent BFB under direct vision with lung lavage of 142 times, and the lung recruitment rate was 91.23% (52/57). At the same time, the culture positive of sputum specimens rate was 66.13%(289/437). The main complications were hypoxia, arrhythmia, trachea hemorrhage after operation, and there was no serious adverse reaction.

The application of BFB on airway management in critically ill patients has better diagnosis and treatment value, and is worth to be popularized.