1、，支氣管鏡的基本操作，方素榮，支氣管鏡檢查前準(zhǔn)備器官-支氣管解剖學(xué)支氣管鏡檢查的基本操作方法，支氣管鏡適應(yīng)性，診斷，原因不明的咯血，慢性咳嗽，沙啞的聲音，限制性哮喘支氣管感染性疾病的病因診斷肺炎胸片檢查或CT檢查異常診斷肺癌的術(shù)前檢查，手術(shù)范圍和估計(jì)預(yù)后食管-支氣管瘺的胸部創(chuàng)傷診斷，支氣管裂傷和破裂被懷疑。在治療方面，支氣管異物的部分肺不張、肺膿、潰瘍等咯血治療誘導(dǎo)氣管插管支氣管鏡治療，支氣管鏡禁止癥，活動(dòng)性出血不矯正的出血傾向尿毒癥，活檢容易出血嚴(yán)重的肺動(dòng)脈高壓，活檢容易出血者嚴(yán)重的心臟，肺功能障礙嚴(yán)重的心律失常，新發(fā)生的心肌梗塞或心絞痛可疑的主動(dòng)脈動(dòng)脈瘤全身狀態(tài)極度失敗的相對(duì)靜脈閉塞綜合癥

2、，支氣管鏡術(shù)前準(zhǔn)備，術(shù)前檢查，了解病史，血壓測(cè)量和心肺檢查胸部CT檢查，凝血時(shí)間，血小板記憶數(shù)乙型肝炎2半ECG血?dú)夥治觥?zhǔn)備患者，對(duì)患者進(jìn)行檢查的目的，意義，手術(shù)方法說(shuō)明術(shù)前簽名手術(shù)前6小時(shí)前30分鐘肌肉注射穩(wěn)定和阿托品術(shù)前切除，氣管-支氣管的解剖結(jié)構(gòu)。煤氣管道，上部固定在喉部，下部與周期管地連接。器官由15-20個(gè)軟骨環(huán)組成，成人氣管直徑18-20毫米，長(zhǎng)度10-13厘米，氣管分叉角度55-65。機(jī)關(guān)前面有甲狀腺，后面和食道相鄰。主支氣管，右主支氣管短粗，平均長(zhǎng)度25毫米，直徑11-15毫米。左主支氣管細(xì)長(zhǎng)，平均長(zhǎng)度為50毫米，直徑為9-11毫米。右側(cè)支氣管，右側(cè)支氣管長(zhǎng)度9毫米，直徑8毫

3、米右中部支氣管長(zhǎng)度8-20毫米，直徑8毫米右中葉支氣管長(zhǎng)度10-20毫米，直徑7毫米右下葉支氣管長(zhǎng)度9毫米，直徑7毫米。左葉支氣管，左左上支氣管距左上支氣管開(kāi)口約5mm，前下方發(fā)舌段。左下葉支氣管距左下葉支氣管開(kāi)口約5毫米，向后發(fā)送段。，支氣管鏡的工作方法，支氣管分枝命名，組1 exercises，步驟1: nose to larynx，The scope is advanced from The nose to The larynx。this step includes local anshesia，step 2330larynx to subglottis，F(xiàn)rom 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，F(xiàn)rom 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，F(xiàn)rom the neutral position the R

6、MB is entered just by twist the wrist to the right and advancing the sheet，F(xiàn)rom 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，F(xiàn)rom 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，F(xiàn)rom 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)，F(xiàn)rom the distal bronchus intermedi us the scope is advanced and the medio-basal segment，step 8a : left lower lobe basal pyrramid，F(xiàn)rom the entrance of the lll bronch