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目的:探讨急诊重症监护病房(EICU)患者在有创机械通气的条件下,应用纤维支气管镜进行支气管肺泡灌洗术(BAL)治疗操作的安全性。方法:48例EICU危重症病人均为有创机械通气患者,BAL术前、中、后分别监测呼吸机及血气分析主要参数,进行比较;并对BAL术中及术后3d内出现的并发症进行记录。结果:BAL患者吸气峰压(PIP)术前与术中比较(P<0.01);潮气量(Vt)、呼吸频率(f)术中与术前比较无明显改变(P>0.05);术中和术后个别患者出现了出血、发热、心律失常等并发症,对症处理后完全缓解,未出现气压伤等严重并发症。结论:BAL操作时呼吸机显示PIP增高,实际气道内压是下降的,呼吸机表现PIP增高是假象,因此有创机械通气下进行BAL一般不会发生气压伤。BAL在EICU危重症患者气道管理方面具有良好的效果和可靠的安全性。
Objective: To investigate the safety of bronchial alveolar lavage (BAL) with fibrobronchoscopy under emergency mechanical ventilation in patients with emergency intensive care unit (EICU). Methods: Forty-eight patients with severe EICU were randomly divided into three groups: the patients with invasive mechanical ventilation, the main parameters of ventilator and blood gas analysis before, during and after BAL were compared, and the complications occurred during and after operation of BAL Record. Results: There was no significant difference between preoperative and postoperative peak inspiratory peak pressure (PIP) in BAL patients (P <0.01), tidal volume (Vt) and respiratory rate (f) Neutralization and postoperative individual patients had bleeding, fever, arrhythmia and other complications, complete symptomatic relief, no serious complications such as barotrauma. CONCLUSIONS: During ventilator operation in BAL, the PIP increases, the actual airway pressure decreases, and the ventilator exhibits an artifact of increased PIP. Therefore, air pressure injury may not occur in BAL with invasive mechanical ventilation. BAL has good results and reliable safety in the management of airways in critically ill patients with EICU.