2020 年第 7 期 第 15 卷

气管插管下纤维支气管镜实时引导金属支架置入术治疗急诊重度恶性中央气道阻塞的效果分析

Therapeutic effect of real-time guided metal stent implantation under bronchoscope with trachea cannula on emergency severe malignant central airway obstruction

作者：阮霞李小燕任召强姜轶张维何杰

英文作者：Ruan Xia Li Xiaoyan Ren Zhaoqiang Jiang Yi Zhang Wei He Jie

单位：成都医学院第一附属医院呼吸与危重症医学科610500

英文单位：Department of Respiratory and Critical Care Medicine First Affiliated Hospital of Chengdu Medical College Chengdu 610500 China

关键词：恶性中央气道阻塞；急诊；气管插管；金属支架；气道 

英文关键词：Malignantcentralairwayobstruction；Emergency；Tracheacannula；Metalstent；Airway

• 摘要：

• 目的探讨气管插管下纤维支气管镜实时引导金属支架置入术治疗急诊重度恶性中央气道阻塞（MACAO）的临床应用价值。方法回顾性分析成都医学院第一附属医院呼吸与危重症医学科于2015年1月至2019年7月诊治的9例急诊重度MACAO患者临床资料，所有患者均行气管插管下纤维支气管镜实时引导金属支架置入术治疗，观察治疗效果。结果9例患者均成功完成金属支架置入，患者术后气道直径明显大于术前［（17.6±2.5）mm比（3.3±1.4）mm］，气促指数评分明显低于术前［0.8（0.4,1.4）分比3.4（2.7,3.8）分］（均P＜0.05）。所有患者术后1、24 h动脉血氧分压和动脉血二氧化碳分压与术前比较均明显改善［（84±4）、（88±6）mmHg（1 mmHg=0.133 kPa）比（43±6）mmHg，（45±6）、（43±4）mmHg比（90±5）mmHg］（均P＜0.05）。9例患者术后1周随访胸部CT及气管镜检查，均未发现支架移位或支架内再狭窄。随访3～6个月发生支架内再狭窄6例，均及时给予纤维支气管镜下介入治疗。结论气管插管下纤维支气管镜实时引导金属支架置入术治疗急诊重度MACAO安全性高，能快速解除气道梗阻。

• Objective To explore the clinical application value of real-time guided metal stent placement under tracheal intubation fiberoptic bronchoscopy in the treatment of emergency severe malignant central airway obstruction (MACAO).Methods The clinical data of 9 emergency patients diagnosed as MACAO and treated in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Chengdu Medical College from January 2015 to July 2019 were retrospectively analyzed. All patients were treated by fiberoptic bronchoscopy under tracheal intubation and real-time guided metal stent placement. The therapeutic effect was observed. Results  Nine patients were successfully completed with metal stent placement. The postoperative airway diameter was significantly larger than that before operation［（17.6±2.5）mm vs （3.3±1.4）mm］；the score of shortness index was significantly lower than that before operation［0.8（0.4,1.4） vs 3.4（2.7,3.8）］(both P＜0.05). Arterial blood oxygen partial pressure and arterial blood carbon dioxide partial pressure of all patients at 1 and 24 hours after operation were significantly higher than those before operation［（84±4）,（88±6）mmHg vs （43±6）mmHg；（45±6）,（43±4）mmHg vs （90±5）mmHg］（all P＜0.05）. No stent displacement or in-stent restenosis was found in 9 patients by chest CT and bronchoscopic examination at 1 month follow-up. In the follow-up period of 3 months to 6 months, 6 cases of in-stent restenosis occurred in the stent and these patients were treated with tracheal endoscopic interventional. Conclusion The real-time guided metal stent implantation under bronchoscope with trachea cannula for the treatment of severe malignant central airway obstruction is safe and effective.