纤维支气管镜辅助拔管对慢性阻塞性肺病合并呼吸衰竭患者撤机的疗效分析

Effect of Fibrobronchoscopy Assisted Extubation on Weaning of Patients with Acute Exacerba- tion of Chronic Obstructive Pulmonary Disease and Respiratory Failure

【目的】探讨利用纤维支气管镜辅助拔管对慢性阻塞性肺疾病急性加重期（AEcOPD）有创机械通气患者撤机的临床疗效。【方法】回顾2006年1月至2011年5月因AECOPD在本院急危重病救治中心接受气管插管有创机械通气并采用低水平压力支持自主呼吸试验（SBT）协助撤机的患者的临床资料，按拔管方式不同分为纤支镜辅助拔管组60例（观察组）和常规拔管组78例（对照组），比较两组撤机成功率及与拔管操作相关的不良反应发生率。【结果】观察组撤机成功率88％与对照组74％比较差异有统计学意义（P〈O．05），观察组不良反应发生率18．3％（11／60）与对照组28．2％（22／78）比较差异无统计学意义（P〉0．05）。【结论】采用纤支镜辅助拔管可以提高AECOPD患者撤机成功率。

To explore the effect of fibrobronchoscopy assisted extubation on weaning of pa tients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and respiratory failure. [Methods] The clinical data of patients with AECOPD who received mechanical ventilation through trachea cannula and were weaned by spontaneous breathing trials（SBT） with lowlevel pressure support ventilation in our hospital from Jan. 2006 to May 2011 were retrospectively analyzed. According to the way of extubation, all patients were divided into fibrobronchoscopy assisted extubation group（observation group, n = 60） and rou tine extubation group（control group, n = 78）. The success rate of weaning and the incidence of extubationre lated side effects were compared between two groups. [Results] There was significant difference in the wea ning success rate between observation group and control group（88% vs 74%）（ P〈0.05）, but there was no significant difference in the incidence of side effects between observation group and control group（18.3% vs 28.2 %）（ P 〈0.05）. [Conclusion] Fibrobronchoscopy assisted extubation can improve the weaning success rate of patients with AECOPD.