床旁纤支镜吸痰联合机械通气治疗慢性阻塞性肺疾病患者的疗效观察  

Observation on the therapeutic effect of bedside bronchoscopy sputum aspiration combined with mechanical ventilation in patients with chronic obstructive pulmonary disease

作　　者：李世泽 赵迪宏 LI Shi-ze;ZHAO Di-hong(Respiratory Department,Jiangmen People's Hospital,Jiangmen 529000,China)

机构地区：[1]广东省江门市人民医院呼吸科,529000

出　　处：《中国实用医药》2024年第20期46-49,共4页China Practical Medicine

摘　　要：目的观察慢性阻塞性肺疾病患者行床旁纤维支气管镜(纤支镜)吸痰联合机械通气治疗的效果。方法80例慢性阻塞性肺疾病患者,根据随机数字表法分为对照组(n=40)和观察组(n=40)。对照组行机械通气治疗,观察组行床旁纤支镜吸痰^(+)机械通气治疗。对比两组临床疗效、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8、C反应蛋白(CRP)]、血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、退热时间及机械通气撤机时间、呼吸力学参数[气道峰压(PIP)、气道阻力(Raw)、动态肺顺应性(Cdyn)、呼吸做功(WOB)]。结果治疗后,观察组TNF-α(4.15±0.64)ng/L、IL-6(21.98±3.62)pg/ml、IL-8(25.24±4.31)μg/L、CRP(72.22±9.51)mg/L均显著低于对照组的(7.04±1.78)ng/L、(54.54±6.55)pg/ml、(49.15±8.78)μg/L、(101.31±11.21)mg/L(P<0.05)。治疗后,观察组PaO_(2)(77.81±14.06)mm Hg(1 mm Hg=0.133 kPa)比对照组的(68.75±12.86)mm Hg更高,PaCO_(2)(41.06±4.25)mm Hg比对照组的(48.69±5.13)mm Hg更低(P<0.05)。观察组患者退热时间(2.26±0.52)d、机械通气撤机时间(5.26±1.23)d均短于对照组的(3.68±1.03)、(8.25±2.12)d(P<0.05)。治疗后,观察组PIP(16.33±2.16)cm H2O(1 cm H2O=0.098 kPa)、Raw(8.20±0.45)cm H2O/(L·s)、WOB(0.34±0.17)J/L显著低于对照组(23.42±2.55)cm H2O、(11.35±0.50)cm H2O/(L·s)、(0.50±0.30)J/L,Cdyn(36.15±7.24)ml/cm H2O高于对照组的(27.20±6.46)ml/cm H2O(P<0.05)。观察组总有效率97.50%显著高于对照组的75.00%(P<0.05)。结论对慢性阻塞性肺疾病患者行床旁纤支镜吸痰联合机械通气治疗后可提高临床疗效,改善炎症因子、血气分析指标、呼吸力学参数,缩短恢复时间,临床可推广。Objective To observe the effect of bedside bronchoscopy sputum aspiration combined with mechanical ventilation in patients with chronic obstructive pulmonary disease.Methods 80 patients with chronic obstructive pulmonary disease were divided into a control group(n=40)and an observation group(n=40)according to random numerical table.The control group received mechanical ventilation treatment,and the observation group received bedside bronchoscopy sputum aspiration^(+)mechanical ventilation treatment.Both groups were compared in terms of clinical efficacy,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL),IL-8,C-reactive protein(CRP)],blood gas parameters[arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))],fever reduction time and mechanical ventilation mechanical ventilation withdrawal time,respiratory mechanical parameters[peak inspiratory pressure(PIP),airway resistance(RAW),dynamic compliance(Cdyn),work of breathing(WOB)].Results After treatment,the observation group had TNF-αof(4.15±0.64)ng/L,IL-6 of(21.98±3.62)pg/ml,IL-8 of(25.24±4.31)μg/L,and CRP of(72.22±9.51)mg/L,which were significantly lower than(7.04±1.78)ng/L,(54.54±6.55)pg/ml,(49.15±8.78)μg/L,and(101.31±11.21)mg/L in the control group(P<0.05).After treatment,the observation group had higher PaO_(2) of(77.81±14.06)mm Hg(1 mm Hg=0.133 kPa)than(68.75±12.86)mm Hg in the control group,and lower PaCO_(2) of(41.06±4.25)mm Hg than(48.69±5.13)mm Hg in the control group(P<0.05).In the observation group,the fever reduction time was(2.26±0.52)d and the mechanical ventilation weaning time was(5.26±1.23)d,which were shorter than(3.68±1.03)and(8.25±2.12)d in the control group(P<0.05).After treatment,the observation group had PIP of(16.33±2.16)cm H2O(1 cm H2O=0.098 kPa),Raw of(8.20±0.45)cm H2O/(L·s)and WOB of(0.34±0.17)J/L,which were significantly lower than(23.42±2.55)H2O,(11.35±0.50)cm H2O/(L·s)and(0.50±0.30)J/L in the control group;Cdyn of(36.15±7.24)ml/cm H2O in th

关 键 词：床旁纤维支气管镜吸痰 机械通气 慢性阻塞性肺疾病 呼吸力学参数 

分 类 号：R563.9[医药卫生—呼吸系统]