支气管—肺泡灌洗辅助治疗急性期ARDS的临床观察  

The clinical effects of bronchoalveolar lavage on ARDS patients at acute stage

作　　者：宋晓聪[1] 胡丹[1] 齐兆鹏[2] 关纯[1] 曲彦[1] 

机构地区：[1]青岛大学医学院附属市立医院ICU [2]青岛大学医学院附属医院神经外科,山东青岛266071

出　　处：《现代生物医学进展》2010年第10期1926-1928,共3页Progress in Modern Biomedicine

基　　金：青岛市科技局立项资助课题(07-2-1-11-nsh);青岛市科技局立项资助课题(09-1-1-4-nsh)

摘　　要：目的:观察纤维支气管镜支气管-肺泡灌洗术辅助治疗急性期ARDS的临床治疗效果。方法:80例ICU住院并发生ARDS后经有创机械通气危重症患者,其中男46例,女34例,年龄36-87岁;随机分为支气管肺泡灌洗辅助治疗组(A组:ARDS发生后第三天行支气管肺泡灌洗一次)和一般吸痰治疗组(B组)。观察2组患者治疗前后体温、呼吸频率、PaO2/FiO2等情况。比较2组肺部感染控制时间窗、有创通气时间、ICU住院时间及住ICU期间死亡例数。结果:A组在灌洗后体温、呼吸频率及PaO2/FiO2较灌洗前有所改善(P<0.05)。在1周的观察期内,A组的各项指标改善情况优于B组,差异有统计学意义(P<0.05)。感染控制窗出现时间及有创机械通气时间明显缩短(P<0.05),2组间ICU住院时间及死亡率无统计学差异(P>0.05)。结论:对ARDS早期病人给予支气管-肺泡灌洗,可以有效提高病人PaO2,改善氧合,准确提供肺部感染的病原学诊断并有效控制感染,为针对原发病的综合治疗创造条件。Objective：To observe the effects of bronchoalveolar lavage on ARDS patients at acute stage with invasive mechanical ventilation.Methods：A total of 80 critical patients（male 46,female 34,aged 36-87 years） with ARDS admitted in the ICU center were randomly divided into 2 groups：Group A patients were treated by fiberoptic bronchoalveolar lavage（FBL）one time at the third day after ARDS occurred.Group B patients were treated by ordinary sputum suctioning at the same time.The parameter changes before and after treatment such as temperature（T）,respiratory rate（RR）,PaO2/ FiO2 in 2 groups were observed,compared with the Pulmonary Infection Control Window（PIC window）,the duration of ventilation,ICU hospitalization time and the mortality between 2 groups.Results：After treatment both T and RR were declined significantly and PaO2/ FiO2 were elevated significantly in group A.Both in PIC window and the duration of ventilation,group A was shorter than that in group B;and all of those results had significant differences.But the ICU hospitalization time and the mortality in 2 groups had no significant differences.Conclusions：The bronchoalveolar lavage can effectively elevate PaO2,improve oxygenation to early stage ARDS patients;it also can provide an accurate etiology diagnosis of pulmonary infection and effective infection control.Through all these it creates condition for comprehensive treatment of the primary disease.

关 键 词：支气管肺泡灌洗 成人呼吸窘迫综合征 有创机械通气 危重症患者 

分 类 号：R563.8[医药卫生—呼吸系统] R454.4[医药卫生—内科学]