fiberoptic bronchoscopy

Fiberoptic bronchoscopy is a new examination technique used in the clinical field in the 1970s. The clinical application range is very wide. Although it is not very large, it can make many diseases hidden in the trachea, bronchus and deep lungs difficult to be diagnosed and diagnosed and treated without surface trauma, which can save many patients from surgery. bitter. After the application of this inspection technique, great progress has been made in the diagnosis and treatment of lung diseases. Basic Information Specialist Category: Respiratory Examination Category: Endoscope Applicable gender: whether men and women apply fasting: not fasting Tips: Poor general condition, physical weakness can not tolerate bronchoscopy. There is a mental disorder that cannot be checked. Chronic cardiovascular disease, such as unstable angina, myocardial infarction, severe arrhythmia, severe heart failure, hypertension, blood pressure before examination is still higher than 160/100mmhg, aneurysm. Normal value The vocal cords have normal activity and color, and the bronchial opening of the trachea and each leaf segment is smooth. The lumen is not narrow, the size is normal, the surface is smooth and tidy, the color is normal, there may be a small amount of mucus, no pus and bloody secretions, no new biological obstruction, no The lungs are atelect. Clinical significance Fiberoptic bronchoscopy is used in the following situations: 1. Defining the nature of the lung mass At present, imaging diagnostic instruments can make a positive diagnosis of the size and location of lung masses, but it is difficult to diagnose the nature of the masses. The use of fiberoptic bronchoscopy combined with biopsy and brush examination techniques can make the diagnosis rate of lung masses positive. Significantly increased. 2, looking for the origin of suspicious and positive sputum cells The sputum cytology found cancer cells, and there was no abnormality in imaging examination. These patients were clinically called occult lung cancer. Through fiberoptic bronchoscopy, the subtle abnormal signs in the bronchi were observed, combined with biopsy and brushing techniques. It can make patients diagnose early and treat early. 3, intractable cough Cough is generally caused by smoking and bronchitis, tuberculosis, endobronchial tuberculosis, pneumonia, foreign body, lung tumors, etc. If there is an unexplained sign of aggravation of cough and a poor cough for treatment, it should be used for fiberoptic bronchoscopy. To clarify the cause. 4, unexplained wheezing Generally, chronic bronchitis and bronchial asthma can cause wheezing. If the patient has no similar medical history and wheezing gradually worsens, this situation often indicates localized stenosis of the trachea and large bronchus. The cause may be tracheal or bronchial tumor, tuberculosis, Foreign body, inflammation, phlegm, etc., should be examined by fiberoptic bronchoscopy as soon as possible to confirm the diagnosis. 5, hemoptysis and blood in the sputum Common causes of hemoptysis are bronchiectasis and lung cancer. Endobronchial tuberculosis, tuberculosis, bronchitis, lung abscess, granuloma, trauma, pulmonary vascular abnormalities, etc., fiberoptic bronchoscopy can identify the cause, but also through the fiberoptic bronchial suction block, local injection of hemostatic drugs to stop bleeding, if necessary Partial tamponade treatment can be performed under the microscope. Insufficient lung disease due to tumor, inflammation, foreign body and other obstruction of the bronchus caused by the corresponding lung tissue atrophy, so once the atelectasis occurs, should be performed as soon as possible to detect the cause, for inflammation, foreign body, sputum, blood clots, etc. Caused by atelectasis, most people can be re-expanded by fiberoptic bronchoscopy. 6, atelectasis 7, the application of tracheal intubation Tracheal intubation guided by the fiberoptic bronchoscope can generally be performed under the patient's awake local anesthesia. The pain and discomfort caused by the operation are light, and the patient is easy to accept. It is especially suitable for patients with unstable fracture and dislocation of the cervical spine. The intubation is under the vision. This is done so that the position of the endotracheal tube can be clearly corrected, and unilateral pulmonary ventilation is required to help accurately insert the catheter into the left and right bronchial tubes. 8, long-term tracheotomy and intubation applications Fiberoptic bronchoscopy can detect and treat complications of long-term tracheotomy or intubation, such as varying degrees of laryngeal injury, tracheal injury, bleeding, infection, etc. 9, clear trachea, bronchial secretions Partially critical, elderly and frail patients, poor cough and expectoration, often caused by sputum obstruction of the airway caused by ventilatory dysfunction, and secondary pulmonary infection or aggravation of lung infection, fiberoptic bronchoscopy can clear airway secretions, and Can take cockroaches for bacterial culture. 10, the application of lung infections The contaminated deep sputum is taken out by the fiberoptic bronchoscope to make the bacterial culture, and the pathogen is confirmed. In addition, bronchoalveolar lavage through the fiberoptic bronchoscope and local injection of antibiotics are beneficial to the absorption of inflammation. 11, diffuse lung disease The use of fiberoptic bronchoscopy for lung biopsy and bronchoalveolar lavage is helpful for diagnosis. 12. Diagnosis of suspected tuberculosis In the case of X-ray chest radiograph showing atypical shadow and no sputum or repeated examination of the patient, no antacid bacteria were found, and bronchoalveolar lavage and brushing were used for diagnosis. In addition, fiberoptic bronchoscopy can be diagnosed. Endobronchial tuberculosis. 13. Assist in the preoperative staging of lung cancer and determine the scope of resection Fiberoptic bronchoscopy to understand the lesions in the bronchi, in particular to determine the closest distance of the edge of the lesion from the protuberance, determine the extent of bronchial and pulmonary resection. 14, burn patient application Burn patients often have scars in the trachea, block the airway and have ventilatory disorders, and clear the airway secretions and scars through the fiberoptic bronchoscope, which is beneficial to improve ventilation. 15, alveolar proteinosis A fiberoptic bronchoscopy lung biopsy can confirm the disease. At the same time, the fiberoptic bronchoscope is used to remove the phospholipids in the alveoli and improve the alveolar ventilation function. 16, severe asthma Patients with severe asthma have airway secretions and mucus plug formation. After routine treatment, bronchoalveolar lavage with fiberoptic bronchoscopy can improve lung ventilation. 17, sharp lung Bronchoalveolar lavage treatment with fiberoptic bronchoscope to remove harmful substances inhaled into the lungs. 18, take foreign objects Trachea and bronchial foreign bodies occur in children, and are also common in the elderly. Foreign bodies taken through the fiberoptic bronchoscope can avoid the pain caused by hard mirrors and surgical foreign bodies. 19, chest trauma and chest surgery application The fiberoptic bronchoscope can clear the blood and secretions in the airway. At the same time, it can understand the location, extent and severity of the tracheal injury. It can also find the complications of the operation and understand the anastomosis of the operation. 20, lung cancer treatment and follow-up after treatment Application of fiberoptic bronchoscopy to follow-up patients with lung cancer surgery and radiotherapy and chemotherapy can understand the treatment effect and whether there is recurrence after treatment. 21, other Tracheoscopic stent placement was performed by fiberoptic bronchoscope. Laser, high-frequency electrocautery, and cryotherapy were used to treat obstructive diseases of the trachea under fiberoptic bronchoscopy. Radiotherapy and chemotherapy were performed in the lung cancer. Instead of thoracoscopy for chest examination, selective bronchial iodine angiography and so on. Inspection result analysis 1. Mucosal surface congestion, edema, with purulent secretions, mostly inflammation. 2. The mucosal surface is not smooth, and new organisms protrude into the cavity and have necrotic attachment, which is more common in tumors. 3. The bronchial lumen becomes small, narrow or obstructed, and foreign bodies, inflammation, tuberculosis and tumors should be considered according to the medical history. 4. A large number of purulent secretions emerge from the bronchi of a leaf segment, considering lung abscess, pneumonia, tuberculosis, bronchiectasis and infection. 5. If there is bloody secretion or active bleeding in the bronchus of a certain leaf segment, bronchial or pulmonary hemorrhage is considered. Precautions Strictly follow the doctor's advice and actively cooperate with the inspection. Bronchoscopy is not possible in the following situations: 1, the general situation is poor, physical weakness can not tolerate bronchoscopy. 2, the spirit is not normal, can not cooperate with the inspection. 3, there are chronic cardiovascular diseases, such as unstable angina, myocardial infarction, severe arrhythmia, severe heart failure, hypertension, blood pressure before examination is still higher than 160/100mmhg, aneurysm. 4, there are chronic respiratory diseases with severe respiratory insufficiency, if you need to check, can be carried out under oxygen supply and mechanical ventilation. 5, anesthesia drug allergy, can not be replaced with other drugs. 6, there are serious bleeding tendency and coagulation mechanism disorders. 7, the respiratory tract has acute suppurative inflammation with high fever, acute asthma attacks and hemoptysis, can be carried out after the condition is relieved. Inspection process 1. The patient is lying flat, the operator stands at the head of the patient, the left hand holds the manipulation part of the mirror body, and the thumb controls the knob. The right hand sends the lens into the nasal cavity to the throat or through the oral cavity of the oral cavity, and along the posterior pharyngeal wall to the throat. 2. When the depth of the general entrance lens is about 15cm, you will see an epiglottis. If you don't see an epiglottis, don't insert it blindly, otherwise it will be easily inserted into the esophagus. Insert the mirror slowly from underneath the epiglottic cartilage, and you can see the glottis. At this time, the patient calmly breathes, and when the squeaking door is opened, the mirror end is quickly inserted into the trachea from the back of the glottis. 3. After the lens enters the trachea, a small amount of anesthetic can be added, and then the distal end of the lens body is adjusted to the natural position, the field of vision is aligned with the lumen, and the shape, mucous color, activity, and sharpness of the trachea are checked from top to bottom. 4. When examining the bronchi, it should be carried out in order. Generally, the right side and the left side are first, and the middle and lower leaves are first. If the lesion is known, the first side, the back side, and finally the main part of the disease. If the patient is weak, focus on the affected side only. 5. The location, shape, size, and ease of bleeding of the lesion should be recorded, and the distance from the opening or ridge of the lung. A biopsy of the lesion should be performed based on clinical diagnosis. When clamping biopsy, strive to repeatedly clamp 2 to 3 pieces of tissue in the same area. If there are pseudomembranes, blood stasis, necrotic tissue and secretions on the surface of the lesion, it should be sucked or clamped open and then bitten into the deep tissue. If the lesion cannot be clamped, brush the smear with a cell brush and send it for pathological examination. 6. After the biopsy, you should pay attention to observe for a while. If the bleeding is unclear, rinse with salt water. If there is no more bleeding or less bleeding, you can exit the bronchoscope. If the bleeding is more than continuous, local injection of ephedrine 1 ~ 2ml, generally can stop. Not suitable for the crowd 1. Large hemoptysis: The inner diameter of the suction tube of the fiberoptic bronchoscope is small, and it is not possible to effectively suck out more blood clots in a short period of time. Therefore, it is not suitable for the hemoptysis. Of course, blood in the sputum is completely allowed to check. 2. Severe lung function: Care should be taken when necessary under adequate oxygen and cardiac monitoring. 3. Patients with severe pulmonary infection and high fever: should be checked after a little control of infection. 4. The general condition is extremely weak or unable to cooperate. 5. Suspected aortic arch tumor. Adverse reactions and risks (1) Laryngeal and bronchospasm: often caused by insufficient local anesthesia or excessive endocrine secretions. An antispasmodic such as isoproterenol or atropine may be administered, and oxygen may be taken if necessary. (2) Heart rhythm disorder: due to ventilatory disorders, hypoxia, should clear the obstruction and give oxygen therapy. (3) Bleeding: caused by inadvertent biopsy operation and damage to the bronchial mucosa. If there is more bleeding, local 1:1000 adrenaline can be used to stop bleeding. (4) fever: more than 72 hours after the microscopic examination, should be given antipyretics or antibiotic treatment. In addition, attention should be paid to aseptic handling and the selection of appropriate disinfectants. (5) Anesthesia allergy: more common in the use of cadherin for local anesthesia, the main symptoms are dizziness, nausea, chest tightness, pale, blood pressure and even breathing difficulties. Can be given oxygen, artificial respiration, intramuscular atropine and so on.