床旁纤维支气管镜在机械通气COPD患者拔除气管插管中的应用研究  

Application of bedside fiberoptic bronchoscopy in extubation of COPD patients with mechanical ventilation

作　　者：唐旭昇 怀佳萍 滕旭升 Tang Xusheng;Huai Jiaping;Teng Xusheng(Department of Emergency Medical Center,Jinhua Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院急诊医学中心,321000 [2]金华市中心医院重症医学科,321000

出　　处：《新医学》2023年第8期560-563,共4页Journal of New Medicine

基　　金：浙江省医药卫生科技计划项目(2020KY1014)。

摘　　要：目的探讨床旁纤维支气管镜在机械通气的COPD患者拔除气管插管中的应用价值。方法采用前瞻性对照研究方法,纳入需气管插管机械通气的COPD患者64例,随机分成研究组(32例)和对照组(32例)。对照组患者在顺利通过自主呼吸试验(SBT)后直接拔除气管插管,研究组患者在顺利通过SBT后行床旁纤维支气管镜检查治疗,治疗后30 min拔除气管插管。比较2组患者性别、年龄、拔管前急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、再插管率、拔管后白细胞、CRP、降钙素原、血气分析指标、ICU住院时间、28 d病死率的差异。结果2组患者的性别、年龄、拔管前APACHEⅡ评分比较差异均无统计学意义(P>0.05)。与对照组相比,研究组患者再插管率减少,拔管后白细胞减少,CRP、降钙素原水平及PaCO_(2)下降,PaO_(2)、氧合指数(PaO_(2)/FiO_(2))升高,且ICU住院时间缩短(P均<0.05)。2组患者的28 d病死率比较差异无统计学意义(P>0.05)。结论机械通气COPD患者在拔除气管插管前行床旁纤维支气管镜治疗能改善氧合,减轻炎症反应,降低再插管率,缩短ICU住院时间。Objective To evaluate the application value of bedside fiberoptic bronchoscopy in the extubation of chronic obstructive pulmonary disease(COPD)patients with mechanical ventilation.Methods A prospective controlled study was conducted in 64 patients with COPD who required endotracheal intubation and mechanical ventilation.All patients were randomly divided into the experimental and control groups,with 32 cases in each group.Patients in the control group were directly extubated after successfully passing the spontaneous breathing test(SBT).Patients in the experimental group received 30-min bedside fiberoptic bronchoscopy after successfully passing SBT,followed by extubation.Gender,age,APACHEⅡscore before extubation,reintubation rate,white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT),indicators of arterial blood-gas analysis,the length of ICU stay after extubation,and 28-d mortality rate were statistically compared between two groups.Results There was no significant difference in gender,age and APACHEⅡscore before extubation between two groups(all P>0.05).Compared with the control group,the reintubation rate of patients was reduced,WBC,CRP,PCT and PaCO_(2) post-extubation were decreased,PaO_(2) and PaO_(2)/FiO_(2) were increased,and the length of ICU stay was shortened(all P<0.05).However,there was no significant difference in the 28-d mortality rate between two groups(P>0.05).Conclusion Bedside fiberoptic bronchoscopy for COPD patients with mechanical ventilation before extubation can improve oxygenation,alleviate inflammatory reaction,reduce reintubation rate,and shorten the length of ICU stay.

关 键 词：慢性阻塞性肺疾病 床旁纤维支气管镜 再插管率 机械通气 炎症反应 

分 类 号：R563.9[医药卫生—呼吸系统]