支气管肺泡灌洗联合有创机械通气治疗慢性阻塞性肺疾病合并肺部感染的临床观察

The study of treating chronic obstructive pulmonary disease complicated with pulmonary infection using bronchoalveolar lavage combined with invasive mechanical ventilation

目的:观察支气管肺泡灌洗(BAL)联合有创机械通气治疗慢性阻塞性肺疾病(COPD)合并肺部感染呼吸衰竭的临床疗效。方法:将58例COPD合并肺部感染呼吸衰竭患者分为治疗组30例及对照组28例。对照组给予内科综合治疗及有创机械通气,治疗组在对照组治疗的基础上每1～2天给予BAL。观察两组患者动脉血气分析指标(pH、PaO2、PaCO2)、肺部湿啰音、痰量、外周血常规白细胞总数、降钙素原的变化,并比较两组有创机械通气时间。结果:治疗4小时后两组患者pH、PaO2、PaCO2均较治疗前明显改善,治疗组较对照组改善更为明显(P<0.05);治疗48小时后pH、PaO2、PaCO2较治疗4小时后进一步改善,治疗组较对照组改善更为明显(P<0.05);治疗第3天所检测血常规白细胞总数及降钙素原均较治疗前降低,治疗组较对照组降低明显(P<0.05);治疗组有创机械通气时间显著低于对照组(P<0.05);治疗后肺部湿啰音及痰量均较治疗前减少,治疗组症状及体征改变较对照组明显。结论:BAL联合有创机械通气治疗COPD合并肺部感染呼吸衰竭患者的临床疗效优于单纯有创机械通气,有利于纠正呼吸衰竭、改善临床症状、控制肺部感染、缩短有创机械通气时间。

Objective：To study effects of invasive mechanical ventilation combined with bronchoalveolar lavage treating patients with chronic obstructive pulmonary disease complicated with pulmonary infection. Methods：58 patients with chronic obstructive pulmonary disease complicated with pulmonary infection were divided into treatment group（ 30 cases） and control group（ 28 cases）. Control group were given conventional therapy and invasive mechanical ventilation,treatment group were given broncboalveolar ]avage on the basis of invasive mechanical ventilation every one or two days. Arterial blood gas index （ pH, PaCO2 , PaO2 ）, moist rales, amount of expectoration, WBC, procalcitonin and the time of invasive mechanical ventilation were meas- ured before and after treatment. Results：Arterlal blood gas index（ pH, PaCO2 , PaO2 ） were significantly improved in both group 4 hours after treatment. But the level of them in treatment group were higher than that in control group. A greater degree of improvement were obtained 48 hours after treatment（ P 〈 O. 05 ） , the level of them in treatment group were higher than that in control group（ P 〈 0.05 ）. The levels of WBC and procalcitonin of treatment group were significantly lower than that of control group 3 days after treatment（ P 〈0.05 ）. The time of invasive mechanical ventilation of treatment group were significantly lower than that of control group （ P 〈 0. 05 ）. Moistrales, amount of expectoration were decreased in both group after treatment, the changes of treatment group is more significant. Condusion：Bronchoalveolar lavage combined with invasive mechanical ventilation were more effective than invasive mechanical ventilation only in the treatment of patients with chronic obstructive pulmonary disease complicated with pulmonary infection. It can effectively correct respiratory failure, improve the symptoms of patients, control pulmonary infection, shorten the time of mechanical ventilation.