支气管镜的基本操作ppt课件

1、，支气管镜的基本操作，方素荣，支气管镜检查前准备器官-支气管解剖学支气管镜检查的基本操作方法，支气管镜适应性，诊断，原因不明的咯血，慢性咳嗽，沙哑的声音，限制性哮喘支气管感染性疾病的病因诊断肺炎胸片检查或CT检查异常诊断肺癌的术前检查，手术范围和估计预后食管-支气管瘘的胸部创伤诊断，支气管裂伤和破裂被怀疑。在治疗方面，支气管异物的部分肺不张、肺脓、溃疡等咯血治疗诱导气管插管支气管镜治疗，支气管镜禁止症，活动性出血不矫正的出血倾向尿毒症，活检容易出血严重的肺动脉高压，活检容易出血者严重的心脏，肺功能障碍严重的心律失常，新发生的心肌梗塞或心绞痛可疑的主动脉动脉瘤全身状态极度失败的相对静脉闭塞综合症

2、，支气管镜术前准备，术前检查，了解病史，血压测量和心肺检查胸部CT检查，凝血时间，血小板记忆数乙型肝炎2半ECG血气分析。准备患者，对患者进行检查的目的，意义，手术方法说明术前签名手术前6小时前30分钟肌肉注射稳定和阿托品术前切除，气管-支气管的解剖结构。煤气管道，上部固定在喉部，下部与周期管地连接。器官由15-20个软骨环组成，成人气管直径18-20毫米，长度10-13厘米，气管分叉角度55-65。机关前面有甲状腺，后面和食道相邻。主支气管，右主支气管短粗，平均长度25毫米，直径11-15毫米。左主支气管细长，平均长度为50毫米，直径为9-11毫米。右侧支气管，右侧支气管长度9毫米，直径8毫

3、米右中部支气管长度8-20毫米，直径8毫米右中叶支气管长度10-20毫米，直径7毫米右下叶支气管长度9毫米，直径7毫米。左叶支气管，左左上支气管距左上支气管开口约5mm，前下方发舌段。左下叶支气管距左下叶支气管开口约5毫米，向后发送段。，支气管镜的工作方法，支气管分枝命名，组1 exercises，步骤1: nose to larynx，The scope is advanced from The nose to The larynx。this step includes local anshesia，step 2330larynx to subglottis，From the larynx

4、the trachea is entered to the subglottic area。if from the head : once the vocal cords are passed the scope is slightly flexfied downw Ards .if from the front : once the vocal cords are passed the scope is slightly flexed upwards。step : follow the curve to the carina，the trachea is not a“straight pip

5、e”；it deviates posterior ly and slighty to the right when approaching the main carina。step 4a 3360 carina to left main bronchus，From the neutral position the lmb is entered just by twist the wrist to the left and advancing for 1，Step 4b : carina to right main bronchus，From the neutral position the R

6、MB is entered just by twist the wrist to the right and advancing the sheet，From the neutral position the left and right main bronchi are entered alternatively just by twist and advancing the scope for few cm。Step 4c : left-right-neutral，step 5a : down-up-left main bronchus，The scope is slowly advanc

7、ed The puled back up The lmb while always keeping it in The middle，Step 5b : down-up right main bronchus，The scope is slowly advanced down The RMB to RLL and puled back upwards while always keeping it it it、Group 2 exercises、step 6a : left main to left upper lobe bronchus，from the lmb the scope is a

8、dvanced to the entrance of the lul bronchus。Step 6b : left main to left lower lobe bronchus，the scope is advanced down the lmb to the entrance of the lll bronchus。Step 6c : right main to right upper lobe bronchus，The scope is advanced down The RMB then with The wrist twist 60 degrees from midline Th

9、e sche，Step 6d : right main to bronchus intermedius，From the carina advance the scope down the RMB to the distal bronchus intermedi us and visualuals，Step 6e : right main to right lower lobe bronchus，Advance the scope from the carina to the entrance of the RLL while always keeping it in the，group 3

10、exercises、Step 7a : left upper lobe uno dos，from the carina，the scope is advanced to lul entrance；There，just by thumb movement，the lingu la and upper division bronchus are visualized。step 7b : left before five six(lb 456)、from the lmb、The lingu la is entered、then The scope is pulled back into The di

11、stal！wrist movements are“in the mirror”，step 7c : left B6-8，9，10，with the scope at the lll bronchus entrance，the superior segment is entered，the antero，step 7d : right upper lobe uno-dos-tres，From the RMB the scope is advanced and flexed up into the rul bronchus where just by wristthen the scope is

12、within to the main carina。step 7e 3360 right before five six(Rb 4、5、6)，from the distal bronchus intermedius，the rml and superior segment are eners！wrist movements are“in the mirror”.step 7f : right rb7 (d artag nan)，From the distal bronchus intermedi us the scope is advanced and the medio-basal segment，step 8a : left lower lobe basal pyrramid，From the entrance of the lll bronch