摘要
目的探讨无痛纤维支气管镜治疗小儿先天性心脏病术后肺部并发症的有效性。方法回顾性分析2009年8月至2012年2月在我院因房间隔缺损、室间隔缺损、法洛四联症、右心室双出口及大动脉转位行手术治疗58例小儿患者的临床资料,其中男26例,女32例;年龄20 d～2岁,应用Olympus xp-60型纤维支气管镜在丙泊酚、芬太尼及利多卡因麻醉下行清除气道分泌物及支气管肺泡灌洗治疗,并观察脉搏血氧饱和度、呼吸音及胸部X线片变化。结果 58例患者行无痛纤维支气管镜检查时间10～25 min,经纤维支气管镜检查吸尽气道分泌物后,患者呼吸状态明显好转,脉搏血氧饱和度上升5%～12%,肺部湿啰音较检查前明显减轻;其中29例肺不张患者经纤维支气管镜诊疗后,次日胸部X线片复查不张的肺叶明显复张,其中8例次日需再行纤维支气管镜检查和治疗后肺叶亦完全复张。1例重度肺动脉高压(PH)患者住重症监护室(ICU)6 d,3例大动脉转位患者住ICU 5 d,3例右心室双出口合并中度PH患者住ICU 4 d,其余患者均在48 h内转出ICU,无1例严重并发症发生,其中2例检查过程中鼻腔黏膜轻微出血,经给予止血药物及局部压迫等对症处理后止血。结论无痛纤维支气管镜用于小儿心脏术后肺部并发症治疗能显著提高疗效,缩短住ICU时间。
Objective To evaluate clinical outcomes of painless flexible fiberoptic bronchoscopy in the treatment for pulmonary complications in postoperative pediatric patients with congenital heart diseases.Methods We retrospectively analyzed clinical data of 58 patients who received fiberoptic bronchoscopy for pulmonary complications after surgical repair for atrial septal defect,ventricular septal defect,tetralogy of Fallot,double outlet right ventricle or transposition of the great arteries in First Affiliated Hospital of Harbin Medical University From August 2009 to February 2012.There were 26 male patients and 32 female patients with their age ranging from 20 days to 2 years.Olympus xp-60 fiberoptic bronchoscopy was used for removal of airway secretions and bronchial alveolar lavage under anesthesia with propofol,fentanyl and lidocaine.Pulse oximetry,respiratory sound and chest X-ray changes were observed.Results The examination time of painless fiberoptic bronchoscopy was 10-25 minutes in the 58 patients.After removal of airway secretions by fiberoptic bronchoscopy,their respiratory status improved significantly,pulse oxygen saturation increased by 5%-12%,and their pulmonary crackles were significantly reduced.In 29 patients with atelectasis,their pulmonary lobes demonstrated significant reexpansion in chest X-ray reviews on the next day after fiberoptic bronchoscopy,and 8 patients received another fiberoptic bronchoscopy treatment on the next day to achieve complete pulmonary reexpansion.One patient with severe pulmonary hypertension（PH） stayed in intensive care unit（ICU） for 6 days,3 patients with transposition of the great arteries stayed in ICU for 5 days,3 patients with double outlet of right ventricle and moderately high PH stayed in ICU for 4 days,and all the other patients were discharged from ICU within 48 hours after admission.There was no severe complication related to fiberoptic bronchoscopy,except 2 patients with minor nasal mucosa bleeding who were cured with hemostatic drugs and local compression.Conclusion Painless flexible fiberoptic bronchoscopy can significantly enhance clinical outcomes and shorten ICU stay for postoperative pediatric patients with congenital heart diseases.
出处
《中国胸心血管外科临床杂志》
CAS
2012年第6期645-647,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
纤维支气管镜
无痛
先天性心脏病
手术
Fiberoptic bronchoscopy
Painless
Congenital heart disease
Surgery
