摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
ObjectiveTo observe the predictive value of Volume OXygeneration (VOX) index for early non-invasive positive pressure ventilation (NIPPV) treatment in patients with type I Respiratory failure. MethodsRetrospective analysis was made on the patients with type I Respiratory failure admitted to the intensive care medicine from September 2019 to September 2022, who received early NIPPV treatment. After screening according to the discharge standard, they were grouped according to the NIPPV 2-hour VOX index. The observation group was VOX Youden index >20.95 (n=69), and the control group was VOX index ≤20.95 (n=64). Collect patient baseline data and NIPPV 2-hour, 12-hour, and 24-hour arterial blood gas values, and calculate NIPPV outcomes, intubation status, NIPPV usage time, hospital stay, and mortality rate. ResultsThere was a statistically significant difference in respiratory rate (RR) between the baseline data onto the two groups of patients, but others not. After early NIPPV treatment, the 2-hour oxygenation index (P/F) [(182.5 ± 66.14) vs. (144.1 ± 63.6) mm Hg, P<0.05] of the observation group showed a more significant increase. The failure rate of NIPPV intubation within 12 hours was lower (4.35% vs. 32.81%, P<0.05), the success rate of NIPPV withdrawal from 24 hours was higher (40.58% vs. 0%, P<0.05), and the failure rate of NIPPV intubation was lower (4.35% vs. 46.88%, P<0.05). The comparison of treatment outcomes showed that the intubation rates in the observation group (4.35% vs. 67.19%, P<0.05) was lower. The threshold of NIPPV 2-hour VOX index 20.95 was used as a predictor of Tracheal intubation, with sensitivity of 74.7% and specificity of 93.5%. ConclusionIn the early NIPPV treatment of patients with type I Respiratory failure, the NIPPV 2-hour VOX index>20.91 is taken as the evaluation index, which can better to predict the improvement in hypoxia and the risk of NIPPV failure Tracheal intubation, and has clinical significance.