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957 图4、图5 肺实变； Figure 4, Figure 5: multifocal consolidation lesions;
958 图6 广泛实变，表现为“白肺 Figure 6: diffuse consolidation, "white lung".
959 四. COVID-19患者诊治中支气管镜技术的应用 IV. Application of Bronchoscopy in the Diagnosis and Management of COVID-19 Patients
960 支气管镜技术在COVID-19患者诊治中具有以下价值： Flexible bronchoscopy is versatile, easy to use, and well tolerated in mechanically ventilated COVID-19 patients. Its applications include:
961 1）留取深部气道标本，提升病毒核酸检出阳性率及病原体培养准确率，合理指导抗菌药物应用； (1) Collection of Respiratory specimens from the lower Respiratory tract (i.e. sputum, endotracheal aspirate, bronchoalveolar lavage) for SARS-CoV-2 or other pathogens guides the selection of appropriate antimicrobials, which may lead to clinical benefits. Our experience indicates that lower respiratory specimens are more likely to be positive for SAR-CoV-2 than upper Respiratory specimens.
962 2）吸痰，清除血痂，解除气道梗阻； (2) Can be used for localization of the site of bleeding, cessation of hemoptysis, sputum or blood clots removal; if the site of bleeding is identified by bronchoscopy, local injection of cold saline, epinephrine, vasopressin, or fibrin as well as laser treatment can be per formed via the bronchoscope.
963 3）协助建立人工气道，引导气管插管或经皮气管切开； (3) Assist in the establishment of artificial airways; guide tracheal intubation or percutaneous tracheotomy.
964 4）气道内给药，如滴注α-干扰素、N-乙酰半胱氨酸。 (4) Drugs such as infusion of α-interferon and N-acetylcysteine can be administrated via the bronchoscope.
965 危重症患者气管镜下可见支气管粘膜广泛充血肿胀，管腔内大量粘液样分泌物潴留，严重者可见粘稠胶冻样痰液堵塞气道，见图7。 Bronchoscopic views of extensive bronchial mucosal hyperemia, swelling, mucus-like secretions in the lumen and jelly-like sputum blocking the air way in critically ill patients. (Figure 7).
966 图7 COVID-19气管镜下表现：支气管粘膜肿胀充血；管腔内见大量粘液样分泌物 Figure 7: Bronchoscopic manifestations of COVID-19: bronchial mucosa swelling and congestion; large amounts of mucus secretions in the lumen