支气管镜的基本操作.pptxVIP

支气管镜的基本操作方苏榕 支气管镜的适应症，禁忌症支气管镜术前的准备工作气管-支气管的解剖结构支气管镜的基本操作方法 支气管镜的适应症诊断方面 不明原因的咯血，慢性咳嗽，声音嘶哑，局限性哮鸣音支气管感染性疾病的病因学诊断肺炎胸片或CT检查异常已诊断肺癌术前检查，指导手术范围及估计预后食管-支气管瘘的确诊胸部外伤，怀疑有支气管裂伤和断裂治疗方面取出支气管异物某些肺不张，肺脓疡等咯血治疗引导气管插管支气管镜下治疗支气管镜的禁忌症 活动性大出血不能纠正的出血倾向尿毒症，活检易出血者严重肺动脉高压，活检易出血者严重心、肺功能障碍严重心律失常新近发生心肌梗死或心绞痛疑有主动脉瘤全身情况极度衰竭严重的上腔静脉阻塞综合征 支气管镜术前准备术前检查了解病史、测量血压及心肺体检胸片或胸部CT检查出、凝血时间、血小板记数乙肝两对半ECG检查血气分析患者准备向患者讲明检查目的、意义、配合方法术前签字术前禁食6小时术前30分钟肌注安定和阿托品有异齿术前摘下? 气管—支气管的 解剖结构气 管上段固定于喉部，下段与主支气管相连接。 气管由15－20个软骨环构成，成人气管横径18－20mm，长度10－13cm，气管分叉角度55－65°。 气管前有甲状腺，后与食道相邻。主支气管右主支气管 短而粗，平均长度25mm，直径11－15mm。左主支气管 细而长,平均长度50mm,直径9－11mm。右侧叶支气管右上叶支气管 长度9mm，直径8mm右中间段支气管 长度8－20mm，直径8mm右中叶支气管 长度10－20mm,直径7mm右下叶支气管 长度9mm,直径7mm左侧叶支气管左上叶支气管 距左上叶支气管开口约5mm处，向前下处方发出舌段。左下叶支气管 距左下叶支气管开口约5mm处，向后发出背段。支气管镜操作方法 支气管分支命名右肺左肺上叶B1尖段上叶上叶分支B1+2尖后段B2后段B3前段B3前段中叶B4外段舌叶B4上舌段B5内段B5下舌段下叶B6背段下叶B6背段B7内基底段B8前基底段B8前基底段B9外基底段B9外基底段B10后基底段B10后基底段Group 1 ExercisesStep 1: nose to larynxThe scope is advanced from the nose to the larynx .This step includes local anesthesiaStep 2: larynx to subglottisFrom the larynx the trachea is entered to the subglottic area.If from the head: once the vocal cords are passed the scope is slightly flexed downwards.If from the front: once the vocal cords are passed the scope is slightly flexed upwards.Step 3: Follow the curve to the carina The Trachea is not a “straight pipe”;It deviates posteriorly and slightly to the right when approaching the main carina.Step 4a: Carina to left main bronchusFrom the neutral position the LMB is entered just by twisting the wrist to the left and advancing for 1 -2 cm.Step 4b: Carina to right main bronchusFrom the neutral position the RMB is entered just by twisting the wrist to the right and advancing the scope for 1 -2 cmStep 4c: Left-right-neutral From the neutral position the left and right main bronchi are entered alternatively just by twisting the wrist and advancing the scope for few cm.Step 5a: Down-up-left main bronchusThe scope is slowly advanced the pulled back u