探讨纤支镜加有—无创序贯通气治疗老年COPD严重呼衰的价值

Treatment of elder COPD induced hypercapnic respiratory failure by fibrous bronchoscopy lavage combined with sequential non-invasive following short-term invasive mechanical ventilation

目的探讨老年慢性阻塞性肺疾病(COPD)严重呼吸衰竭采用纤支镜加有一无创序贯机械通气治疗的价值。方法对重症COPD并呼吸衰竭病人,采用纤支镜吸痰、灌洗加有—无创序贯机械通气治疗为治疗组(A组)和单用普通吸痰管吸痰加有创机械通气治疗为对照组(B组),比较二组病例有创和总机械通气时间、机械通气后住院天数、撒机成功/失败例数、病死率及呼吸机相关性肺炎(VAP)的发生情况。结果A组治疗后除病死率(1/31)(3.22%)及撤机成功例数(30)/失败例数(1)与B组的病死率(1/30)(3.33%)撤机成功例数(29)/失败例数(1)相仿(P>0.05)外,余有创和总机械通气时间、机械通气后住院天数、及呼吸机相关性肺炎(VAP)的等各项指标均明显优于B组,显示两组间差异有显著性(P<0.05)。结论纤支镜加有一无创序贯机械通气是治疗COPD严重呼吸衰竭患者安全的、有效的手段,能迅速控制感染、缩短了有创机械通气时间,减少了气管插管VAP等并发症的发生,还可缩短住院时间、改善预后,有较好的临床实用价值,值得推广应用。

Objective To study the worth of fibrous bronehoseope lavage combined with sequential non-invasire following short-term invasive mechanical ventilation in Chronic obstructive pulmonary disease （COPD） with hypereapnie respiratory failure, Methods The eases were made up of the study group （A Group） and the control group （B Group）, The patients were treated with fibrous bronehoseopc lavage combined with sequential non-invasive following short-term invasive mechanical ventilation （MV） as study group, the others control group received invasive rentilation modality. Compare the duration of invasive MV, the total duration of ventilatory support, the duration of hospitalization after ventilation, mortality rate and the incidence of Ventilator Associated Pneumonia （VAP）, Results For A group and B group, the groups had similar clinical mortality rate, 3,22% vs 3.33%, P〉0.05. The duration of invasive MV, the total duration of ventilatory support, the rate of VAP, the duration of hospitalization after ventilation, P〈0.05, Conclusions The therapy of fibrous bronehoseope lavage combined with sequential non-invasive following short-term invasive mechanical ventilation is safe and effective in COPD with hypercapnie respiratory failure. It can control infection, decrease the durations of MV and hospitalization, reduce the incidence of the complication. For example, VAP. This kind of method deserves the expansion application.