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目的 探讨纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用.方法 2008年1月至2009年10月收治的慢性阻塞性肺疾病(COPD)并发Ⅱ型呼吸衰竭120例分为纤维支气管镜插管组60例采用纤维支气管镜引导下经鼻气管插管,经口气管插管组60例采用经口气管插管,进行观察.结果 纤维支气管镜插管组纤维支气管镜引导下经鼻气管插管全部病例均一次插管成功,一次性插管成功率100%,插管时间1～2 min,无一例插管时发生心跳、呼吸骤停,血压下降,气管破裂,气管损伤,咯血等并发症.经口气管插管组由于患者气道分泌物过多、肥胖等原因咽喉暴露不充分出现插管困难7例;插管时发生发生心跳、呼吸骤停3例.结论 纤维支气管镜引导下经鼻气管插管明显优于经口管插管具有操作简单,创伤小,并发症发生少,同时可以清理呼吸道,以迅速纠正阻塞、改善通气.

Objective To explore the fiberoptic bronchoscope-guided nasal intubation and mechanical ventilation in COPD and respiratory failure in the application.Methods From January 2008 to October 2009admitted to chronic obstructive pulmonary disease (COPD)complicated by respiratory failure,120 cases of type Ⅱ fiberoptic bronchoscope intubation group was divided into 60 cases using fiberoptic bronchoscope-guided tracheal intubation through the nose,orotracheal intubation group,60 cases with orotracheal intubation,were observed.Results The fiberoptic bronchoscope fiberoptic bronchoscope intubation group under the guidance of nasal intubation All patients had an intubation success,one-time success rate of intubation was 100%,intubation time.for 1-2 min,and no case occurs when intubation heartbeat and breathing arrest,blood pressure,tracheal rupture,tracheal injury,complications such as hemoptysis.Orotracheal intubation group of patients with airway due to excessive secretion,obesity and other reasons are not fully exposed to the throat there seven cases of difficult intubation;intubation occurs when heart rate,respiratory arrest in 3 cases.Conclusion The fiberoptic bronchoscope-guided tracheal intubation through the nose is better than oral intubation with a simple operation,trauma and fewer complications,and can clear the respiratory tract,quickly correct to the obstruction and improve ventilation.