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

Authors：

曾玲 ¹ , 王鹏 ¹ , 薛扬 ¹ ,  钱永军 ²

1. ;
2. ;

Corresponding author：

钱永军, Email: yongjunqian@sina.com

Keywords：

DOI：

10.7507/1007-4848.20150265

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目的探讨纤维支气管镜（纤支镜）在体外循环术后机械通气患者中的应用。方法回顾性分析2014年1～12月行纤支镜检查76例体外循环术后机械通气患者的临床资料，男45例、女31例，年龄21～71（42.8±6.3）岁。其中行二尖瓣置换术35例，主动脉瓣置换术11例，二尖瓣置换术+主动脉瓣置换术17例，冠状动脉旁路移植术5例，升主动脉+主动脉全弓或半弓人工血管置换术8例。术前心功能Ⅱ级25例、Ⅲ级39例、Ⅳ级12例。术前合并中、重度肺动脉高压13例，感染性心内膜炎5例。结果 76例患者中气道大量分泌物59例，气道严重充血、水肿明显9例，痰痂阻塞气管导管3例，血痂阻塞气管导管2例，导管部分闭塞2例，气道轻微渗血1例。59例经纤支镜检查吸出气道分泌物后，肺部湿啰音较检查前明显减轻，呼吸状态明显好转；其余17例也经纤支镜检查进行准确诊断和有效处理。本组患者在纤支镜检查中顺利完成痰液标本采集共31例，未发生缺氧、心律失常和出血等操作并发症。结论体外循环术后机械通气患者行纤支镜检查，在维持呼吸道通畅、正确指导抗生素应用、辅助诊断治疗中有积极作用。

Citation： 曾玲, 王鹏, 薛扬, 钱永军. 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

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2.	刘婷婷,康焰.人工气道拔除的影响因素和预测指标.华西医学,2014,29(11):2183-2186.
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5.	王春梅,支修益,白书媛,等.开胸手术后下呼吸道感染病原菌及其耐药分析.中国胸心血管外科临床杂志,2011,18(2):126-129.
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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.
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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.	徐克劲.体外循坏手术肺保护的研究进展.中国医师杂志,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. 赖军华,廖碧.纤维支气管镜肺泡灌洗治疗心脏术后并发肺部感染患者的临床观察.临床研究,2012,9(10):65-66.
2. 刘婷婷,康焰.人工气道拔除的影响因素和预测指标.华西医学,2014,29(11):2183-2186.
3. 尹清,李天成,徐燕.纤维支气管镜在体外循环围术期急症的应用.中国内镜杂志,2009,15(3):328-329.
4. 姚德胜.纤支镜清除机械通气患者下呼吸道痰痂20例分析.急诊医学,2000,9(1):63.
5. 王春梅,支修益,白书媛,等.开胸手术后下呼吸道感染病原菌及其耐药分析.中国胸心血管外科临床杂志,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. 徐克劲.体外循坏手术肺保护的研究进展.中国医师杂志,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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