支气管冲洗术联合无创正压通气抢救COPD呼吸衰竭合并肺不张的疗效观察  

Effect of bronchical lavage combined with NIPPV in rescuing respiratory failure in COPD complicating atelectasis

作　　者：陈为忠 谢伟见 王雅杰 叶卫庆 冯丽丽 黄雯雯 李高楼 钱川 

机构地区：[1]上海市闵行区吴泾医院,上海200241

出　　处：《现代医药卫生》2011年第2期182-183,共2页Journal of Modern Medicine & Health

摘　　要：目的:探讨支气管冲洗术联合无创正压通气(NIPPV)抢救慢性阻塞性肺疾病(COPD)呼吸衰竭合并肺不张的治疗价值。方法:将COPD呼吸衰竭合并肺不张患者随机分为两组,治疗组22例、对照组20例。治疗组在监护下备好急救设施后,按纤维支气管镜检查要求,插入纤支镜后先吸出气道内滞留的分泌物,然后用冲洗液反复冲洗,直到分泌物基本清除,支气管冲洗完毕后接面罩行NIPPV,第二、三天患者气道分泌物多(或肺不张无改善)则再次进行气管冲洗术;对照组只单纯给予NIPPV治疗。结果:治疗组第一次支气管冲洗前后比较PaO2有显著升高,PaCO2有显著下降(P<0.01),15例进行第二次支气管冲洗后较冲洗前PaO2上升不明显(P>0.05),而PaCO2则有显著下降(P<0.05)。肺不张有17例完全复张。对照组NIPPV前后PaO2亦有显著上升(P<0.01),PaCO2则有显著下降(P<0.05)。治疗组治疗成功19例,成功率86.4%,改为有创通气3例,未见严重并发症发生;对照组治疗成功15例,成功率75%,差异有非常显著性(P<0.01)。治疗组NIPPV治疗时间、住院时间、肺完全复张时间明显缩短,住院费用明显降低。结论:支气管冲洗术联合NIPPV抢救COPD呼吸衰竭合并肺不张安全有效,值得临床进一步研究。Objective：To observe the value of bronchoalveolar lavage（BAL） combined with non-invasive positive pressure ventilation（NIPPV） in the treatment of respiratory failure in chronic obstructive pulmonary disease（COPD） patients with atelectasis.Methods：COPD patients of respiratory failure were randomly divided into two groups,treatment group（22 cases） and control group（20 cases）.The patients of treatment group received fiberoptic bronchoscopy（FOB） under care after rescue equipments were prepared.According to the standard procedures of FOB,the secretes held in airway were aspirated out,then the airway was repeatedly washed until the secretes were removed almost completely.The patients received NIPPV by mask following bronchial lavage.If the amount of sputum increased in the second or third day,bronchial lavage could be repeated.The patients in the control group received only NIPPV.Results：In treatment group,PaO2 increased significantly after the first BAL,while PaCO2 decreased significantly（P0.01）.In 15 cases,PaO2 did not increase significantly after the second BAL（P0.05）.While PaCO2 decreased significantly（P0.05）.17 cases of atelectasis were completely recovered.In control group,PaO2 increased significantly after NIPPV（P0.01）,while PaCO2 decreased（P0.05）.In the treatment group,19 cases were treated successfully,the rate of success was 86.4%.3 cases had to receive invasive mechanical ventilation;no case suffered severe complication.In control group,15 cases were treated successfully,the rate of success was 75%.The difference between the two groups was significant（P0.01）.The durations of non-invasive mechanical ventilation and hospitalization,the time that the lung completely recovered in treatment group were shortened obviously compared with control group.Hospitalization expense decreased obviously in treatment group.Conclusion：Bronchial lavage combined with NIPPV is safe and effective in rescuing respiratory failure of COPD patients with atelectasis.The technique

关 键 词：肺疾病 阻塞性 支气管冲洗术 无创正压通气 肺不张 

分 类 号：R5[医药卫生—内科学]