无创正压通气联合纤维支气管镜肺泡灌洗对老年AECOPD合并Ⅱ型呼吸衰竭患者肺功能及血气指标的影响

Effect of Noninvasive Positive Pressure Ventilation Combined with Fiberoptic Bronchoscopy Alveolar Lavage on Pulmonary Function and Blood Gas Index in Elderly Patients with AECOPD and Type Ⅱ Respiratory Failure

目的:观察无创正压通气(NIPPV)联合纤维支气管镜(FB)肺泡灌洗对老年急性加重期慢性阻塞性肺疾病(AECOPD)合并Ⅱ型呼吸衰竭患者肺功能及血气指标的影响,为临床治疗方案的选择提供依据。方法:选取82例于2017年1月~2019年1月间在我院住院治疗的老年AECOPD合并II型呼吸衰竭患者。根据治疗方法将患者分为观察组(NIPPV联合FB肺泡灌洗治疗,n=42)与对照组(单独NIPPV治疗,n=40)。观察两组患者的住院时间及抗菌药静脉滴注时间,并比较治疗前及治疗后两组患者的血气指标[pH值(pH)、氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2)]、肺功能指标[一秒钟用力呼气容积(FEV1)、肺活量(FVC)、呼气峰值流速(PEF)]的变化情况。记录两组患者治疗过程中的并发症发生情况。结果:观察组住院时间及抗菌药物静脉滴注时间均明显短于对照组(P<0.05)。治疗后,两组pH、PaO2、SaO2明显上升,而PaCO2明显下降(P<0.05),且与对照组比较,观察组的pH、PaO2、SaO2明显较高,而PaCO2明显较低(P<0.05)。治疗后,对照组FEV1、FVC、PEF无明显变化(P>0.05),观察组FEV1、FVC、PEF均明显升高且高于对照组(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P<0.05)。结论:NIPPV联合FB肺泡灌洗治疗对老年AECOPD合并II型呼吸衰竭患者血气指标及肺功能均有较好的改善效果,能明显缩短患者的住院时间及抗菌药静脉滴注时间,且安全性良好。

Objective:To observe the effect of noninvasive positive pressure ventilation(NIPPV)combined with fiberoptic bronchoscopy(FB)alveolar lavage on pulmonary function and blood gas index in elderly patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)and type II respiratory failure,and to provide basis for clinical treatment.Methods:82 elderly patients with AECOPD and type II respiratory failure who were hospitalized in our hospital from January 2017 to January 2019 were selected.According to the treatment method,the patients were divided into observation group(NIPPV combined with FB alveolar lavage,n=42)and control group(NIPPV alone,n=40).The changes of blood gas indexes(pH,PaO2,PaCO2,SaO2),pulmonary function indexes(FEV1,FVC,PEF)were compared before and after treatment.The complications of the two groups were recorded.Results:The hospitalization time and the intravenous drip time of antibiotics in the observation group were significantly shorter than that in the control group(P<0.05).After treatment,the pH,PaO2 and SaO2 of the two groups increased significantly,while PaCO2 decreased significantly(P<0.05).Compared with the control group,the pH,PaO2 and SaO2 of the observation group were significantly higher,while PaCO2 was significantly lower(P<0.05).After treatment,FEV1,FVC and PEF in the control group had no significant change(P>0.05),but FEV1,FVC and PEF in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P<0.05).Conclusion:NIPPV combined with FB alveolar lavage can improve the blood gas index and lung function of the elderly patients with AECOPD and type II respiratory failure,which can obviously shorten the hospitalization time and the intravenous drip time of antibiotics,and has good safety.