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目的：研究入住ＲＩＣＵ 急性呼吸衰竭患者在纤支镜引导下经鼻插管行机械通气的临床应用价值。方法与结果：操作均由熟练掌握纤支镜使用的专科人员进行，共行２３６ 例次纤支镜引导下经鼻插管，所有经鼻插管均一次成功。男性１６７ 例，女性４８ 例，年龄范围１５ ～９１ 岁，平均６６ ．７ 岁。插管时间为３０ｓ～２ｍｉｎ。插管留置时间最短３ｄ，最长１０６ｄ ，平均２３ ．８ｄ。１１ 例插管２ 次，５ 例插管３ 次，余均为１ 次。插管管腔痰痂形成１ 例。６ 例插管脱出。暂时性血氧饱和度下降６２ 例次（２６．３％ ） ，窦性心动过速５４ 例次（２２ ．９％ ） ，室性早搏８ 例（３ ．４％ ） ，血压升高１６ 例次（６．８％ ），鼻衄３ 例次（１ ．３ ％ ）。结论：纤支镜引导下经鼻插管准确、快捷，对周围软组织损伤小，插管易于固定，病人痛苦少，容易接受。口腔卫生清洁方便，可减少误吸感染机会。对肺部感染亦有诊断及治疗价值。纤支镜引导经鼻插管比经口插管有更多的优点，且安全可靠
Objective: To study the clinical value of mechanical ventilation in nasal cannula guided by fiberoptic bronchoscopy in patients with RICU acute respiratory failure. Methods and Results: The operation was performed by specialists who were well-versed in bronchofiberscopy. 236 cases underwent fiberoptic bronchoscopy guided transnasal cannulation, and all transnasal intubation was successful. There were 167 males and 48 females, with an average age of 66 from 15 to 91 years. 7 years old. Intubation time is 30s ~ 2min. The shortest intubation time of 3d, the longest 106d, an average of 23. 8d. 11 cases of intubation 2 times, 5 cases of intubation 3 times, the remaining were 1 times. Intubation tube sputum scab formation in 1 case. 6 cases of intubation prolapse. Temporary oxygen saturation decreased 62 cases (26.3%), 54 cases of sinus tachycardia (22.9%), 8 cases of premature ventricular contractions (3.4%), blood pressure increased 16 cases (6.8%), epistaxis in 3 cases (1.3%). CONCLUSION: Nasal cannulation guided by fiberoptic bronchoscopy is accurate and quick, with less damage to the surrounding soft tissue. The intubation is easy to fix and the patient has less pain and is easy to accept. Oral hygiene, easy to clean, can reduce the chance of infection by mistake. The diagnosis of pulmonary infection also has therapeutic value. Fiberoptic bronchoscopy guided transnasal intubation than oral intubation has more advantages, and safe and reliable