Baumann M H, Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston.
Chest. 1990 Mar;97(3):721-8. doi: 10.1378/chest.97.3.721.
Bronchopleural fistulas are associated with high morbidity and mortality and are particularly challenging in the ventilated patient. Familiarity with both basic and more technical medical management techniques may lessen morbidity and improve survival. Prompt recognition of BPFs and appropriate placement of a chest tube with an adequate suction device are crucial to prevent potential tension pneumothorax and to drain an infected pleural space. The chest tube may be used therapeutically to decrease BPF air leak and to promote fistula repair. Appropriate conventional ventilator manipulations aimed at decreasing fistula air leak and maintaining adequate oxygenation and ventilation may fail and necessitate a trial of HFV. Definitive therapy by the bronchoscopic application of a sealing agent to occlude the fistula site can be used, particularly in the poor surgical candidate.
支气管胸膜瘘与高发病率和死亡率相关，对于机械通气患者尤其具有挑战性。熟悉基本和更专业的医疗管理技术可能会降低发病率并提高生存率。及时识别支气管胸膜瘘并使用合适的吸引装置正确放置胸管对于预防潜在的张力性气胸和引流感染的胸腔至关重要。胸管可用于治疗以减少支气管胸膜瘘漏气并促进瘘口修复。旨在减少瘘口漏气并维持充足氧合和通气的适当常规呼吸机操作可能无效，因此需要尝试高频通气。可采用通过支气管镜应用封闭剂封堵瘘口部位的确定性治疗，特别是对于手术条件较差的患者。
