肺功能测定-李楠【诊断学课件】精选.pptVIP

* Post Procedure Management My routine post bronchoscopy management consists of the following: Observation Period Based on Procedure Done: Post bronchoscopy management is mainly followed to screen for complications. The complications of routine bronchoscopy are negligible. Vital Signs: It is a good idea to observe the patient following the bronchoscopy. I do not keep the patient under observation for longer than a half an our following a routine bronchoscopy. If a transbronchial lung biopsy was done, the period of observation should be two hours. I dont obtain a routine chest x-ray following a bronchoscopy. However, it is important to get a chest x-ray following a transbronchial biopsy to rule out pneumothorax. This complication does not occur following a routine bronchoscopy. Instructions to the patient I always give the following instructions to my patients: Not to eat or drink for another two hours. The gag reflex should return before he can resume oral consumption. Someone should drive the patient home if theyve been given demerol or valium. Anticipate a sore throat and take a throat lozenge. Call if a fever, shortness of breath or chest pain develops. Anticipate mild hemoptysis. Post Bronchoscopy Sputum: Some physicians routinely collect post bronchoscopy sputum for cytology. While it seems logical, a retrospective study failed to confirm its utility. * * 吸氧 鼻导管 面罩——中间带孔可通过支气管镜 机械通气： 无创——BiPAP 有创 目标: SpO2 90% * 术后处理 观察： 住院患者：术后观察24-48小时 门诊患者：时间视所行操作而定 生命征观察至少2小时 必要时拍胸片：TBLB后一小时， 有呼吸困难者 告知患者 禁食、水2小时 应用镇静剂者需有人陪同回家 可能会出现咽痛、少量咯血 咳嗽重可服用镇咳药 出现发热、呼吸困难、大咯血或胸痛及时就诊 * 诊断性支气管镜技术 * 诊断性操作 黏膜/新生物活检 (可视/盲法) 经支气管肺活检(TBLB, Tranbronchial Lung Biopsy, TBLB) 黏膜刷片 局部冲洗 支气管肺泡灌洗(BAL, bronchoalveolar lavage) 经支气管针吸活检(TBNA , trans bronchial needle aspiration), EBUS-TBNA * EBUS-TBNA 肺癌的诊断 纵隔肺门病变的诊断 肺癌淋巴结分期 * 治疗性支气管镜技术 * 常见介入治疗适应症 引导气管插管、清除气道分泌物、灌注药物 大气道狭窄 冷冻、电灼烧、球囊扩张、支架植入 气管、支气管异物 气道新生物 电凝、激光烧蚀、冷冻、腔内放疗等治疗 * 球囊扩张术 适应证： 1）中心气道狭窄，远端气道通畅者 病程短、狭窄长度短、狭窄程度轻者扩