Fiberoptic Bronchoscopy for the Patients with Mechanical Ventilation after Cardiopulmonary Bypass Operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

曾玲 ¹ , 王鵬 ¹ , 薛揚 ¹ ,  錢永軍 ²

1. ;
2. ;

Corresponding?author：

錢永軍, Email: yongjunqian@sina.com

Keywords：

DOI：

10.7507/1007-4848.20150265

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目的探討纖維支氣管鏡（纖支鏡）在體外循環術后機械通氣患者中的應用。方法回顧性分析2014年1～12月行纖支鏡檢查76例體外循環術后機械通氣患者的臨床資料，男45例、女31例，年齡21～71（42.8±6.3）歲。其中行二尖瓣置換術35例，主動脈瓣置換術11例，二尖瓣置換術+主動脈瓣置換術17例，冠狀動脈旁路移植術5例，升主動脈+主動脈全弓或半弓人工血管置換術8例。術前心功能Ⅱ級25例、Ⅲ級39例、Ⅳ級12例。術前合并中、重度肺動脈高壓13例，感染性心內膜炎5例。結果 76例患者中氣道大量分泌物59例，氣道嚴重充血、水腫明顯9例，痰痂阻塞氣管導管3例，血痂阻塞氣管導管2例，導管部分閉塞2例，氣道輕微滲血1例。59例經纖支鏡檢查吸出氣道分泌物后，肺部濕啰音較檢查前明顯減輕，呼吸狀態明顯好轉；其余17例也經纖支鏡檢查進行準確診斷和有效處理。本組患者在纖支鏡檢查中順利完成痰液標本采集共31例，未發生缺氧、心律失常和出血等操作并發癥。結論體外循環術后機械通氣患者行纖支鏡檢查，在維持呼吸道通暢、正確指導抗生素應用、輔助診斷治療中有積極作用。

Citation： 曾玲, 王鵬, 薛揚, 錢永軍. Fiberoptic Bronchoscopy for the Patients with Mechanical Ventilation after Cardiopulmonary Bypass Operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1071-1073. doi: 10.7507/1007-4848.20150265 Copy

1.	賴軍華,廖碧.纖維支氣管鏡肺泡灌洗治療心臟術后并發肺部感染患者的臨床觀察.臨床研究,2012,9(10):65-66.
2.	劉婷婷,康焰.人工氣道拔除的影響因素和預測指標.華西醫學,2014,29(11):2183-2186.
3.	尹清,李天成,徐燕.纖維支氣管鏡在體外循環圍術期急癥的應用.中國內鏡雜志,2009,15(3):328-329.
4.	姚德勝.纖支鏡清除機械通氣患者下呼吸道痰痂20例分析.急診醫學,2000,9(1):63.
5.	王春梅,支修益,白書媛,等.開胸手術后下呼吸道感染病原菌及其耐藥分析.中國胸心血管外科臨床雜志,2011,18(2):126-129.
6.	Raja SG,Dreyfus GD.Modulation of systemic inflammatory response after cardiac surgery.Asian Cardiovasc Thorac Ann,2005,13(4):382-395.
7.	Baufreton C,Corbeau JJ,Pinaud F.Inflammatory response and haematological disorders in cardiac surgery:toward a more physiological cardiopulmonary bypass.Ann Fr Anesth Reanim,2006,25(5):510-520.
8.	Khan H,Belsher J,Yilmaz M,et al.Fresh-frozen plasmaand platelet transfusions are associated with development of acutelung injury in critically ill medical patients.Chest,2007,131(5):1308-1314.
9.	Zilberberg MD,Carter C,Lefebvre P,et al.Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill:a cohort study.Crit Care,2007,11(3):R63.
10.	Székely A,Cserép Z,Sápi E,et al.Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations.Ann Thorac Surg,2009,87(1):187-197.
11.	Kimura N,Tanaka M,Kawahito K,et al.Risk factors for prolonged mechanical ventilation following surgery for acute type aortic dissection.Circ J,2008,72(11):1751-1757.
12.	Wang Y,Xue S,Zhu H.Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery.J Cardiothorac Surg,2013,8(1):118-124.
13.	Nakajima T,Kawazoe K,Izumoto H,et al.Risk factors for hypoxemia after surgery for acute type A aortic dissection.Surg Today,2006,36(8):680-685.
14.	徐克勁.體外循壞手術肺保護的研究進展.中國醫師雜志,2004,6(11):1583-1584.
15.	Khamiees M,Raju P,Degirolamo A,et al.Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial.Chest,2001,120(4):1262-1270.

1. 賴軍華,廖碧.纖維支氣管鏡肺泡灌洗治療心臟術后并發肺部感染患者的臨床觀察.臨床研究,2012,9(10):65-66.
2. 劉婷婷,康焰.人工氣道拔除的影響因素和預測指標.華西醫學,2014,29(11):2183-2186.
3. 尹清,李天成,徐燕.纖維支氣管鏡在體外循環圍術期急癥的應用.中國內鏡雜志,2009,15(3):328-329.
4. 姚德勝.纖支鏡清除機械通氣患者下呼吸道痰痂20例分析.急診醫學,2000,9(1):63.
5. 王春梅,支修益,白書媛,等.開胸手術后下呼吸道感染病原菌及其耐藥分析.中國胸心血管外科臨床雜志,2011,18(2):126-129.
6. Raja SG,Dreyfus GD.Modulation of systemic inflammatory response after cardiac surgery.Asian Cardiovasc Thorac Ann,2005,13(4):382-395.
7. Baufreton C,Corbeau JJ,Pinaud F.Inflammatory response and haematological disorders in cardiac surgery:toward a more physiological cardiopulmonary bypass.Ann Fr Anesth Reanim,2006,25(5):510-520.
8. Khan H,Belsher J,Yilmaz M,et al.Fresh-frozen plasmaand platelet transfusions are associated with development of acutelung injury in critically ill medical patients.Chest,2007,131(5):1308-1314.
9. Zilberberg MD,Carter C,Lefebvre P,et al.Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill:a cohort study.Crit Care,2007,11(3):R63.
10. Székely A,Cserép Z,Sápi E,et al.Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations.Ann Thorac Surg,2009,87(1):187-197.
11. Kimura N,Tanaka M,Kawahito K,et al.Risk factors for prolonged mechanical ventilation following surgery for acute type aortic dissection.Circ J,2008,72(11):1751-1757.
12. Wang Y,Xue S,Zhu H.Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery.J Cardiothorac Surg,2013,8(1):118-124.
13. Nakajima T,Kawazoe K,Izumoto H,et al.Risk factors for hypoxemia after surgery for acute type A aortic dissection.Surg Today,2006,36(8):680-685.
14. 徐克勁.體外循壞手術肺保護的研究進展.中國醫師雜志,2004,6(11):1583-1584.
15. Khamiees M,Raju P,Degirolamo A,et al.Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial.Chest,2001,120(4):1262-1270.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Fiberoptic Bronchoscopy for the Patients with Mechanical Ventilation after Cardiopulmonary Bypass Operation

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