纤维支气管镜肺灌洗对AECOPD合并Ⅱ型呼吸衰竭患者肺功能及炎性因子的影响

Effects of fiberoptic bronchoscopy lung lavage on pulmonary function and arterial blood gas in patients with AECOPD combined with type Ⅱ respiratory failure

目的观察纤维支气管镜肺灌洗治疗对慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭肺功能及炎性因子的影响。方法选取2015年1月—2017年5月陕西省汉中市人民医院呼吸内科收治AECOPD伴Ⅱ型呼吸衰竭患者97例作为研究对象,按随机数字表法分为常规组(n=41)和研究组(n=56)。患者均给予常规药物治疗,常规组另予以无创正压通气治疗,研究组在常规组治疗的基础上予以纤维支气管镜肺灌洗治疗。比较2组患者的临床疗效、肺功能、血清可溶性髓系细胞触发受体-1(sTREM-1)、高迁移率族蛋白1(HMGB-1)水平以及不良反应。结果治疗2周后,研究组总有效率为96.43%,明显高于常规组的82.93%(χ~2=5.126,P=0.023);呼吸频率、心率降低程度显著优于常规组(t=-9.791、-7.585,P<0.01);FVC、FEV_1及PEF升高程度显著优于常规组(t=2.371、2.623、2.268,P<0.05);PaCO_2、PaO_2改善程度显著优于常规组(t=-9.291、3.630,P<0.01);血清sTREM-1、HMGB-1水平降低程度显著优于常规组(t=-7.267、-13.469,P<0.01);2组患者不良反应发生率比较差异无统计学意义(χ~2=0.093,P=0.760)。结论在常规药物及无创呼吸机治疗的基础上予以纤维支气管镜肺灌洗治疗AECOPD伴Ⅱ型呼吸衰竭,可以显著提高临床疗效,改善患者的肺功能、血气状况以及炎性反应,且未加重不良反应,值得临床重视。

Objective To observe the effects of fiberoptic bronchoscopy lung lavage on pulmonary function and arterial blood gas in patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） combined with type II respiratory failure. Methods Ninety-seven cases of AECOPD combined with type Ⅱ respiratory failure in department of respiratory of Hanzhoung People＇s Hospital from January 2015 to May 2017 were selected as research object, according to the treatment plan, the patients were divided into the conventional group（n =41） and the study group（n = 56）. All patients were given routine medication, the conventional group was treated with non-invasive positive pressure ventilation. On the basis of conventional group, the study group was treated with fiberoptic bronchoscopy lung lavage. The clinical efficacy, lung function, adverse reaction and serum sTREM-1 and HMGB-1 levels were analyzed and compared between the two groups. Results After 2 weeks of treatment, the total efficiency of the study group was significantly higher than that of the conventional group（96.43% vs 82.93%, χ^2 =5. 126, =0.023）; The decreasing degree of respiratory rate and heart rate in the study group were significantly better than that of the routine group（t=9. 791, t =-7. 585, P〈0. 01）; The levels of FVC, FEV_1 and PEF in the study group were significantly higher than the conventional group（ t = 2. 371,t= 2. 623.t= 2. 268,P〈0. 05）; The improvement of PaCO_2 and Pa02 in the study group was significantly better than that of the conventional group（t = 9.291, t =3.630, P〈0.05）; The serum sTREM-1 and HMGB-1 levels decreased in the study group were significantly better than that of the control group（t =-7. 267, t =-13. 469, P〈0. 01）; There was no significant difference in the incidence of adverse reactions between the two groups（χ^2 =0. 093, P = 0. 760）. Conclusion On the basis of conventional drugs and non-invasive positive pressure ventilation treatment, fiberoptic bronchoscopy lung lavage in the treatment of AECOPD with type Ⅱ respiratory failure can significantly improve the clinical efficacy, improve the lung function, blood gas status and inflammatory reaction,and with less adverse reactions, it is worthy of clinical application.