有创机械通气的危重症患者支气管肺泡灌洗临床观察

The clinical effects of bronchoalveolar lavage on critical patients with invasive mechanical ventilation support

目的观察经纤维支气管镜支气管肺泡灌洗和经吸痰管注水后吸出方式灌洗的临床效果。方法93例行机械通气的危重症患者,其中男性59例,女性34例,年龄18～92岁;随机分为两组。进行经纤维支气管镜支气管肺泡灌洗(A组)和经吸痰管注水后吸出方式灌洗(B组)。观察并比较两组对象灌洗前后的气道峰压(PIP)、内源性PEEP(PEEPi)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)及有创机械通气时间、重症监护病房(ICU)入住时间和病死率。结果两组的PIP和PEEPi较灌洗前均有明显下降;两组组间△PIP、△PEEPi比较,A组大于B组;两组的PaCO2较灌洗前有明显下降,两组的PaO2均较灌洗前有明显升高;A组分别在PaCO2降低和PaO2升高的程度上优于B组;A组有创机械通气时间和ICU入住时间均较B组明显缩短;以上比较差异均有统计学意义。但两组病死率差异无统计学意义。结论对有创机械通气的危重症患者进行经纤维支气管镜支气管肺泡灌洗或经吸痰管注水后吸出方式灌洗,均可以改善呼吸力学参数和血气参数。经纤维支气管镜支气管肺泡灌洗效果优于经吸痰管注水后吸出方式灌洗,值得广泛开展。

Objective To observe the effects of bronchoalveolar lavage on critical patients with invasive mechanical ventilation support. Methods A total of 93 critical patients（male 59, female 34, aged 18 - 92 years） with invasive mechanical ventilation support admitted in the ICU center were randomly divided into 2 groups： Group A patients were treated by fiberoptic bronchoalveolar lavage（FBL）. Group B patients were treated by ordinary lavage. The parameter changes before and after treatment such as peak airway pressure（PIP）, intrinsic positive end-expiratory pressure（PEEPi）, PaO2 and PaCO2 in 2 groups were observed, compared with the duration of ventilation, hospitalization time and the mortality between 2 groups. Results After treatment both PIP and PEEPi were declined significantly in 2 groups. Compared with parameters of both APIP and APEEPi, group A were higher than that in group B. After treatment PaCO2 was declined significantly and PaO2 was elevated significantly in 2 groups. In group A had a better effect than group B both on PaCO2 decrease and PaO2 elevation after treatment. Both in duration of ventilation and hospitalization time, group A was more shorter than that in group B; and all of those results were significant differences. But the mortality in 2 groups had no significant difference. Conclusion The treatment of FBL or ordinary lavage on the critical patients with invasive mechanical ventilation support can improve both respiratory dynamic parameters and arterial gas parameters. The effects of FBL are better than ordinary lavage. It is demonstrated that the FBL should be more widely used in ICU.