摘要
目的分析80岁以上机械通气患者并发气管内肉芽肿临床特点并观察钬激光治疗的临床疗效。方法7例80岁以上患者均经气管切开长期行呼吸机辅助治疗并发气管肉芽肿，行经气管镜钬激光肉芽肿切除术，观察治疗前后患者的临床表现、血气分析、机械通气参数等变化。术后180d复查，观察肉芽肿复发情况，并记录并发症。结果本组7例均可见气管内肉芽肿形成，临床表现为逐渐出现喘鸣、呼吸和心率增快、血氧饱和度（SaO2）和血氧分压（PaO2）下降及二氧化碳分压（PaCO2）升高，潮气量（TV）逐渐减少、气道峰压（Ppeak）逐渐增高。治疗后喘鸣消失，呼吸、心率分别从治疗前（45±11）次／min、（140±12）次／min下降到（18±8）次／min、（72±20）次／min，血pH、Pa02、Sa02分别由7．18±0．02、（40±10）mmHg、（70．4±5．8）％上升到7．40±0．02、（79±13）mmHg、（95．1±3．9）％，PaCO2由（82±11）mmHg下降至（40±6）mmHg，TV由（150±34）ml／min上升到（410±35）ml／min，Ppeak由（65．9±5．7）cm H2O下降到（25．1±3．3）cm H2O，治疗前后各指标比较，差异均有统计学意义（P〈0．01）。治疗后30、60、180d未见复发。治疗中未发生并发症。结论80岁以上长期行机械通气患者并发气管肉芽肿逐渐形成，容易误诊；经气管镜钬激光切除疗效显著、安全可靠。
Objective To investigate the clinical features of the endotracheal granuloma resulting from long-term mechanical ventilation, and to evaluate the clinical efficacy and safety of holmium laser treatment under bronchoscope. Methods Seven advanced elderly patients with longterm mechanical ventilation and complicating endotracheal granuloma in Beijing Hospital were treated with holmium laser under bronchoscope. The respiratory rate, heart rate, arterial blood gas analysis and parameters of mechanical ventilation were recorded before and after treatment. The granuloma recurrences were fellowed up 30, 60 and 180 days after operation. Complications were noted during the operation. Results Seven octogenarian patients with long-term mechanical ventilation were found to have endotracheal granuloma. Clinical symptoms of the granuloma included wheezing, gradual increase in respiratory rate and heart rate. Arterial blood gas analysis showed that pH, PaO2 and SaO2 gradually decreased and PaCO2 increased. Tidal volume gradually decreased and peak pressure in air way increased. After holmium laser therapy, patients＇ states of the illness were obviously improved. There was no more dyspnoea. Respiratory rate and heart rate decreased from （45±11） times/min, （140 ± 12） breats/min to （18 ± 8） times/min, （72 ± 20） breats/min, respectively. The levels of pH, PaO2 and SaO2 increased from 7. 18±0.02, （40±10） mm Hg, （70.4±5.8）% to 7. 40±0.02, （79±13） mm Hg, （95.1±3.9）% respectively and PaCO2 decreased from （82±11） mm Hg to （40±6） mm Hg, tidal volume increased from （150±34） ml/min to （410±35） ml/min, peak pressure in air way decreased from （65.9±5.7） cm H2O to （25. 1±3.3） cm H2O. All the patients recovered from the holmium laser treatment of granuloma. The granulomas was no more seen when bronchoscope was repeated 30, 60 and 180 days after operation. No complications were observed during the operation. Conclusions Endotracheal granuloma resulting from long-term mechanical ventilation can gradually form and easily be misdiagnosed. Holmium laser therapy under bronchoscope is a safe and effective method in advanced elderly patients.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2007年第6期420-422,共3页
Chinese Journal of Geriatrics
关键词
钬
激光手术
肉芽肿
呼吸道
支气管镜检查
连续气道正压通气
Holmium
Laser surgery
Granuloma, respiratory tract
t3ronchoscopy
Continuous positive airway pressure ventilation
