支气管冲洗术联合无创正压通气抢救慢性阻塞性肺疾病呼吸衰竭的疗效研究

Effect of bronchial lavage combined with non-invasive positive pressure ventilation in rescuing of respiratory failure in chronic obstructive pulmonary disease patients

目的探讨支气管冲洗术联合无创正压通气(NIPPV)抢救慢性阻塞性肺疾病(COPD)呼吸衰竭的治疗价值。方法将COPD呼吸衰竭患者随机分为二组,治疗组(22例),对照组(24)例。治疗组在监护下并备好急救设施后,按纤维支气管镜(纤支镜)检查要求,插入纤支镜后先吸出气道内滞留的分泌物,然后用冲洗液反复冲洗,直到分泌物基本消除,支气管冲洗完毕后接面罩进行NIPPV,第2、3天若气道分泌物多(≥50 ml/d)则再次进行支气管冲洗术;对照组则单纯给予NIPPV治疗。结果治疗组第一次支气管冲洗前后比较PaO_2有非常显著升高,PaCO_2有非常显著下降(P<0.01),15例进行第二次支气管冲洗后较第二次冲洗前PaO_2上升不明显(P>0.05),而PaCO_2则有显著下降(P<0.05)。对照组无创通气前后PaO_2亦有显著上升(P<0.01),PaCO_2则有显著下降(P<0.05)。治疗组治疗成功19例,成功率86.4%,改为有创通气者3例,未见严重并发症发生;对照组治疗成功18例,成功率75%,差异非常显著(P<0.01)。治疗组无创通气治疗时间、住院时间较对照组明显缩短,住院费用明显降低。结论支气管冲洗术联合NIPPV抢救COPD呼吸衰竭安全有效,值得临床进一步研究。

Objective To observe the value of bronchial lavage combined with non invasive positive pressure ventilation（NIPPV） in the treatment of respiratory failure in chronic obstructive pulmonary disease （COPD） patients. Methods COPD patients of respiratory failure were randomly divided into two groups, treatment group（22 cases）, control group（24 cases）. The patients of treatment group received fiberoptic bronchoscopy（FOB） under care after rescue equipments were prepared. According to the standard procedures of FOB, the secretes held in airway were first aspirated out, then the airway was repeatedly washed until the secretes were removed almost completely. Then the patients received NIPPV by mask following bronchial lavage. If the amount of sputum increased in the second or third day,bronchial lavage may be repeated. The patients in the control group received only NIPPV. Results In treatment group,PaO2 increased significantly after the first BAL,while PaCO2 decreased significantly（ P 〈0.01）. In 15 cases,PaO2 did not increase significantly after the second BAL（ P 〈0.05） while PaCO2 decreased significantly（ P 〈 0.05）. In control group, PaO2 increased significantly after NIPPV（ P 〈0.01 ）, while PaO2 decreased（ P 〈0.05）. In treatment group,19 cases were treated successfully, the rate of success was 86.4% ; 3 cases had to receive invasive mechanical ventilation; no case suffered severe complication. In control group, 18 cases were treated successfully,the rate of success was 75% . The difference between the two groups was significant（ P 〈 0.01）. The durations of non-invasive mechanical ventilation and hospitalization were shortened obviously in treatment group than those in control group. Hospitalization expenses decreased obviously in treatment group. Conclusions Bronchial lavage combined with NIPPV is safe and effective in rescuing respiratory failure of COPD patients. The technique is worth further research.