经纤支镜支气管肺泡灌洗术治疗急性呼吸衰竭在重症监护病房的临床应用

Clinical application of broncho-alveolar lavage in the patients with acute respiratory failure in ICU

目的探讨经纤维支气管镜支气管肺泡灌洗术治疗急性呼吸衰竭在重症监护病房的临床应用效果。方法选择胸科术后、颅脑术后、创伤昏迷、慢性阻塞性肺疾病患者共35例,均有明显的气道分泌物排出困难、肺不张、肺部感染伴呼吸衰竭、急性呼吸衰竭的表现,均经常规氧疗、抗感染、解痉、平喘、化痰或机械通气等治疗无效后,在重症监护病房采用床旁纤支镜气管吸引及支气管肺泡灌洗、局部注射药物治疗,并监测心电、血压、呼吸、血氧饱和度变化及进行血气分析。结果所有病例经治疗后,临床症状改善,血气分析PaO_2、SaO_2与治疗前相比有明显增高(P<0.05)。结论纤支镜气道吸引、支气管肺泡灌洗、局部注射药物的疗法效果确切,能迅速缓解患者因气道阻塞所致肺不张、呼吸困难,有利于气道管理和肺部感染的控制,明显缩短了患者留住重症监护病房的时间及住院周期,降低了住院费用,值得临床推广。

Objective To investigate the clinical applications of broncho-alveolar lavage in the patients with acute respiratory failure in ICU. Methods The clinical data of 35 patients with respiratory failure, together with diffieuhy to cough up phlegm, atelectasis or pulmonary infection were chosen. These patients were treated with suction, broncho-alveolar lavage and local injection under bronchofiberscope and monitored the heart rate, blood pressure, respiration, oxygen saturation of blood and blood gas analysis, when it is ineffective in the treatment of oxygen therapy, anti-infection, spasmolysis, antiasthmatic, expectorant, or mechanical ventilation. Results In all treated patients the clinical symptoms were improved, the PaO2 and SaO2 were markedly increased compared with those before treatment （P 〈 0. 05）. Conclusion The treatment with suction, broncho-alveolar lavage and local injection under bron- chofiberscope is effective in the treatment of patients with acute respiratory failure and can rapidly relieve atelectasis and dyspnea caused by airway obstruction and is helpful in airway management and infection control,and it can significantly shorten patients＇stay time in the ICU, reduce hospitalization time and cost, and can be widely clinically applied.