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目的探讨急诊纤维支气管镜(简称纤支镜)技术在严重多发伤急救中的作用。方法应用该技术对24例急诊严重多发伤患者行纤支镜引导经鼻气管插管、气道管理等检查,分析总结其诊断与治疗特点。结果对9例患者在纤支镜引导下进行经鼻气管插管,进行呼吸机辅助通气;5例经口插管7～10 d 后改经鼻插管。应用纤支镜分别诊断外伤性气管断裂、左总支气管下端断裂各1例,及时进行手术治疗后好转。对17例次肺部感染或合并叶、段肺不张、肺实变患者作出正确诊断,并进行气管及支气管内吸痰,其中对11例严重脑外伤、严重肺挫伤伴多发肋骨骨折、颈椎外伤高位截瘫等并发肺不张患者行支气管肺泡灌洗。术后患者血氧饱和度及氧分压明显升高,复查胸部 CT 或胸片,肺均基本复张。好转出院19例,多器官功能衰竭死亡或家属放弃治疗5例。结论急诊床旁纤支镜技术在严重多发伤急救中具有重要作用,是创伤急救中必备的急救技术,值得在急诊科推广应用。
Objective To investigate the role of emergency fiberoptic bronchoscopy (bronchofibroscopy) in emergency treatment of severe multiple trauma. Methods The technique was applied to detect the characteristics of diagnosis and treatment in 24 cases of severe trauma patients undergoing bronchofibroscopy and endotracheal tube tracheal intubation and airway management. Results Nine patients underwent nasal endotracheal intubation under nasal cannula guided by ventilator assisted ventilation. Five patients underwent nasal intubation after 7 to 10 days of oral intubation. The application of bronchoscopy were diagnosed traumatic tracheal rupture, the left bronchial rupture of the lower end of 1 case, promptly after surgery improved. Seventeen patients with pulmonary infection or complicated with lobes, atelectasis and pulmonary consolidation were diagnosed correctly, and tracheal and endobronchial suctioning were performed. Among them, 11 cases of severe traumatic brain injury, severe pulmonary contusion with multiple rib fractures and cervical spine Traumatic high paraplegia complicated by atelectasis in patients with bronchoalveolar lavage. Postoperative patients with oxygen saturation and oxygen pressure was significantly elevated, chest CT or chest X-ray examination, the lungs are basically complex. Nineteen patients were discharged, five died of multiple organ failure or their families gave up treatment. Conclusion Emergency bedside fiberoptic bronchoscopy plays an important role in the emergency treatment of severe multiple trauma and is an essential first aid technique in emergency trauma. It is worth popularizing and applying in emergency department.