支气管镜肺泡灌洗联合无创通气治疗重症肺炎合并呼吸衰竭的疗效观察  

Clinical effect of bronchoalvoelar lavage combined with noninvasive ventilation on respiratory failure in patients with severe pneumonia

作　　者：卢滨[1] 吴红科[1] 姚菲菲[1] 张翠翠[1] 

机构地区：[1]河南省郑州人民医院呼吸内科,郑州450003

出　　处：《广西医科大学学报》2018年第1期68-71,共4页Journal of Guangxi Medical University

摘　　要：目的:探讨支气管镜肺泡灌洗(BAL)联合无创通气治疗重症肺炎合并呼吸衰竭的疗效。方法:选择2013年1月至2016年6月河南省郑州人民医院收治的80例重症肺炎伴呼吸衰竭患者,分为观察组和对照组,每组40例。对照组患者给予无创正压通气治疗,观察组在对照组治疗基础上给予BAL治疗。比较两组治疗总有效率、血气指标、肺功能及血清炎症因子高迁移率族蛋白B1(HMGB-1)、可溶性髓系细胞触发受体-1(sTREM-1)水平。结果:观察组疗效显著优于对照组(P<0.05);治疗后,两组动脉氧分压(PaO_2)、血氧饱和度(SaO_2)、最大呼气中期流速(FEF25%~75%)及肺一氧化碳弥散量(DLCO)均明显增加(均P<0.05),且观察组显著高于对照组(P<0.05);两组血清HMGB-1、sTREM-1水平均显著降低(均P<0.05),且观察组显著低于对照组(P<0.05)。结论:BAL联合无创通气治疗重症肺炎合并呼吸衰竭临床效果显著,可明显改善血气状态及肺功能,降低炎性因子表达水平,值得临床推广。Objective： To investigate the clinical effect of bronchoalvoelar lavage （BAL） combined with nonin- vasive ventilation on respiratory failure in severe pneumonia patients. Methods： 80 severe pneumonia patients with respiratory failure treated in our hospital from January 2013 to June 2016 were enrolled and were randomly divided into an observation group and a control group, with 40 cases in each group. Patients in the control group received noninvasive positive-pressure ventilation, and those in the observation group were treated as the control group with addition of BAL. The total response rate, pulmonary function, blood gas and inflammatory factors levels were observed and compared. Results： The response rate in the observation group was significantly higher than that in the control group （P〈0. 05）. Compared with the control group, the PaO2, SaO2, FEF25%-75%, and DLCO were obviously increased, while the levels of high-mobility group box 1 protein （HMGB-1） and soluble triggering receptor expressed on myeloid cell-1 （sTREM-1） in serum were decreased in the observation group （P〈 0. 05）. Conclusion： BAL combined with noninvasive positive-pressure ventilation was effective in severe pneumonia patients with respiratory failure. It could improve pulmonary function and inhibit inflammatory response.

关 键 词：重症肺炎 呼吸衰竭 无创通气 支气管镜肺泡灌洗 

分 类 号：R563.1[医药卫生—呼吸系统]