Shaffer J P, Allen J N
The Ohio State University Medical Center, Division of Pulmonary and Critical Care Medicine, Columbus 43210, USA.
Chest. 1998 Nov;114(5):1378-82. doi: 10.1378/chest.114.5.1378.
To determine the clinical utility of placing airway stents to facilitate weaning in ventilator-dependent patients with large airway obstruction.
A chart review of mechanically ventilated patients who received expandable metal airway stents to attempt a facilitation of weaning.
Eight patients, 3 women and 5 men, ranging in age from 37 to 82 years, had respiratory failure associated with large airway obstruction and underwent flexible bronchofluoroscopic placement of 12 expandable metal stents (7 Wallstents [Schneider; Minneapolis, MN], 2 Palmaz [Johnson & Johnson; Warren, NJ], and 3 Ultraflex [Microinvasive; Natick, MA]). Six had respiratory failure that was secondary to malignant airway disease, and two had benign airway disease. Seven patients with tracheal or mainstem bronchial obstruction were weaned from the ventilator within 0 to 11 days of stent placement after having previously required mechanical ventilation from 2 to 52 days. There were no associated complications. Following prolonged attempts at weaning, one patient with lobar bronchus obstruction died after mechanical ventilation was withdrawn.
Expandable metal airway stents may be safely deployed in mechanically ventilated patients and can facilitate weaning from the mechanical ventilator. Mechanically ventilated patients with tracheal and mainstem bronchus obstruction are the best candidates for deployment of expandable airway stents to facilitate weaning.
确定在依赖呼吸机的大气道梗阻患者中放置气道支架以促进撤机的临床实用性。
对接受可扩张金属气道支架以尝试促进撤机的机械通气患者进行病历回顾。
8例患者，3例女性和5例男性，年龄37至82岁，患有与大气道梗阻相关的呼吸衰竭，并接受了12个可扩张金属支架的柔性支气管荧光镜置入术（7个Wallstent支架[施奈德公司；明尼阿波利斯，明尼苏达州]，2个Palmaz支架[强生公司；沃伦，新泽西州]，3个Ultraflex支架[微创公司；纳蒂克，马萨诸塞州]）。6例呼吸衰竭继发于恶性气道疾病，2例患有良性气道疾病。7例气管或主支气管梗阻患者在支架置入后0至11天内成功撤机，此前他们需要机械通气2至52天。无相关并发症。经过长时间的撤机尝试，1例叶支气管梗阻患者在撤机后死亡。
可扩张金属气道支架可安全地应用于机械通气患者，并能促进机械通气撤机。气管和主支气管梗阻的机械通气患者是放置可扩张气道支架以促进撤机的最佳人选。
