Sriratanaviriyakul Narin, Lam Francis, Morrissey Brian M, Stollenwerk Nicholas, Schivo Michael, Yoneda Ken Y
*Division of Pulmonary, Critical Care, and Sleep Medicine †Department of Internal Medicine, University of California, Davis, Sacramento ‡VA Northern California Health Care System, Mather, CA.
J Bronchology Interv Pulmonol. 2015 Oct;22(4):288-93. doi: 10.1097/LBR.0000000000000203.
Airway obstruction from blood clots, airway secretions, and foreign bodies is a potentially life-threatening condition. Optimal management of this problem, whether by rigid or flexible bronchoscopy, has not been well studied. We report our single-center experience on the safety and clinical utility of cryoprobe extraction for this indication.
We performed a retrospective chart review from January 2006 to November 2014 of all subjects aged 18 and older who underwent flexible bronchoscopic cryoprobe extraction. Subjects with obstruction due to benign or malignant neoplasm or airway stenosis were excluded.
A total of 38 cryotherapy sessions performed on 30 subjects were identified for inclusion. Cryoprobe extraction was successful in reestablishing airway patency in 32/38 (84%) sessions overall and in 24/26 (92%) for blood clots, 4/6 (67%) for mucous plugging, 2/4 (50%) for foreign bodies, and 2/2 (100%) for plastic bronchitis. Twenty-one of 31 (68%) sessions resulted in improvement in oxygenation or ventilation. There was 1 complication related to sedation.
We conclude that flexible bronchoscopic cryoprobe extraction of blood clots, mucous secretions, plastic bronchitis, and foreign bodies is a safe and effective option. It can be safely performed at the bedside and in many cases eliminates the need for rigid bronchoscopy.
由血凝块、气道分泌物和异物导致的气道阻塞是一种潜在的危及生命的状况。对于这一问题的最佳处理方法，无论是通过硬质支气管镜还是软质支气管镜，都尚未得到充分研究。我们报告了我们单中心关于冷冻探头取出术在此适应证方面的安全性和临床实用性的经验。
我们对2006年1月至2014年11月期间所有年龄在18岁及以上接受软质支气管镜冷冻探头取出术的患者进行了回顾性病历审查。排除因良性或恶性肿瘤或气道狭窄导致阻塞的患者。
共确定30名患者接受了38次冷冻治疗并纳入研究。总体而言，冷冻探头取出术在38次操作中有32次（84%）成功恢复气道通畅，其中血凝块导致的阻塞在26次操作中有24次（92%）成功，黏液阻塞在6次操作中有4次（67%）成功，异物导致的阻塞在4次操作中有2次（50%）成功，塑料支气管炎在2次操作中有2次（100%）成功。31次操作中有21次（68%）使氧合或通气得到改善。有1例并发症与镇静有关。
我们得出结论，软质支气管镜冷冻探头取出血凝块、黏液分泌物、塑料支气管炎和异物是一种安全有效的选择。它可以在床边安全进行，并且在许多情况下无需进行硬质支气管镜检查。
