Bronchoscopy (Introduction)

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After 1967, with fiber bronchoscope developed by Ikeda et al (hereinafter referred to as bronchoscopy) to clinical application, transbronchi

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After 1967, with fiber bronchoscope developed by Ikeda et al (hereinafter referred to as bronchoscopy) to clinical application, transbronchial lung biopsy (TBLB), bronchoalveolar lavage (BAL) technology and various interventional treatment tools, application of bronchoscopy in clinic has been further improved and popularized. At present, bronchoscopy can not only be used for the diagnosis and treatment of tracheobronchial diseases, but also can be used to evaluate the disease of the peripheral lung, and even help the staging of bronchogenic carcinoma, guiding treatment.

(a) bronchoscopy indications and contraindications to diagnosis 1 pneumonitis unexplained bloody sputum or hemoptysis of unknown causes of unexplained recurrent atelectasis and slowly absorbed the cough or wheeze limitation of unexplained hoarseness, recurrent laryngeal nerve paralysis or phrenic nerve paralysis chest imaging expression of cancer cells were found in solitary nodule or lump shadow sputum, chest imaging staging of trachea negative pulmonary infection by anti pollution brush or BAL diagnosis of isolation and identification of pathogenic bacteria of unclear diffuse lung diseases need to do BAL and TBLB to check the suspected food tract fistula observation of toxic gases caused by airway injury and burn selective bronchial radiography lung cancer or incision of tracheal intubation catheter after suspected tracheal stenosis airway granulation tissue hyperplasia, tracheobronchial cartilage softening treatment indications 2 removal of trachea Bronchial foreign bodies in the establishment of artificial airway treatment of endobronchial tumor in the treatment of bronchial stenosis airway stent placed removal of tracheobronchial viscous secretion in 3 contraindications to narcotic drug allergy ventilation dysfunction caused by CO2 retention, and no ventilatory support measures of gas exchange dysfunction, oxygen or oxygen respirator after arterial oxygen pressure is still lower than the safe range of heart insufficiency, severe hypertension and arrhythmia were intracranial hypertension from aortic aneurysm blood coagulation, platelet 75000/mm3 "recent asthma attacks, or unstable asthma without controls or in the course of massive hemoptysis hemoptysis in 2 weeks time to stop short range of subjects' general condition the spirit of high tension, no drug control who (two) application of bronchoscopy in the diagnosis of the 1 Evaluation of tracheobronchial mucosal biopsy specimens taken 2 3 diagnostic Bronchoalveolar lavage 4 brush sampling 5 transbronchial needle aspiration (three) application of bronchoscopy in the treatment of 1 removal of foreign bodies in 2 for secretion retention 3 remove the pathological basis of airway stenosis 4 expansion of airway 5 treatment of bronchial fistula in 6 patients with hemoptysis (four) bronchoscopy treatment complications and adverse reactions in 1 bronchoscopy sometimes in the bronchoscope through the upper airway, glottis into the trachea in the process of showing the throat, bronchial spasm, apnea, even severe complications such as cardiac arrest. Usually associated with inadequate patient preparation. When the mood is too tight, the proper use of sedatives and skilled operation is the key. 2 a number of life-threatening complications associated with anesthesia and related abnormal blood gas bronchoscopy are associated with the use of drugs and local anesthesia. Aggravating factors include advanced age, cardiovascular disease, chronic lung disease, abnormal liver and kidney function, epilepsy and mental status changes. Moderate sedation, anti anxiety, muscle relaxants can increase patient cooperation, easy to check. However, when there is organ dysfunction, the dosage should be adjusted in order to reduce the complications such as respiratory depression, hypotension and arrhythmia. 3 fever and infection during bronchoscopy, often can damage the mucosa, it is recommended that routine antibiotic prophylaxis. In particular, prophylactic antibiotics should be used in patients with prosthetic valves, surgical shunt, or endocarditis. 4 with the development of interventional bronchoscopy, the complications such as airway perforation or airway obstruction which were rarely seen in the diagnostic bronchoscopy were gradually increased. The complication of perforation is easy to be caused by laser, electric chromium or cryotherapy, especially the experience of the surgeon, the penetrating power of the instrument and the poor precision of the control range of the treatment. Can be serious with bleeding, pneumothorax or mediastinal emphysema. The common causes of airway obstruction are stents, photodynamic therapy and cryotherapy. 5 the probability of pneumothorax was about 4% after bronchoscopic biopsy under the guidance of pneumothorax. The incidence of pneumothorax was higher without fluoroscopy guidance. The incidence of pneumothorax was not related to the size of the bronchoscopic biopsy forceps, which was mainly affected by the underlying disease. When pneumothorax is over 20%, it should be treated by thoracic drainage or intubation. 6 bleeding is one of the most common complications associated with bronchoscopy. Preoperative evaluation of coagulation function can be avoided to some extent. Platelet count "50000/mm2" should avoid bronchoscopy. It is possible to perform a bronchoscopic biopsy or invasive intervention only when the platelet count (75000/mm3) is performed. In addition, the incidence of bleeding in patients with uremia after endoscopic surgery is also very high, up to 45%. BUN higher than 300 mg/L or higher than 30 contraindications creatinine mg/L is bronchoscopy surgery. A small amount of bleeding, the local infusion of 1:10000 epinephrine can be a good effect. A large number of bleeding, should be based on the cause of bleeding, the location and the degree of damage to the blood vessels and select the appropriate drug for the cause of the disease, local high pressure balloon compression and other hemostatic measures. Attachment: I introduce my Department of bronchoscopy and treatment began in 2003, in 2009 has been replaced by electronic bronchoscopy, smaller diameter, better image definition, patient comfort is also significantly improved. At present, nearly 2000 cases have been diagnosed and treated, with a group of skilled and emergency medical team.

 

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