肺泡灌洗术联合机械通气治疗重症肺部感染的临床观察

Clinical observation of bronchoalveolar lavage combined with mechanical ventilation in the treatment of severe pulmonary infection

目的探讨纤维支气管镜支气管肺泡灌洗术(BAL)联合机械通气治疗重症肺部感染的安全性及临床效果。方法对我院ICU 55例重症肺部感染呼吸衰竭患者建立人工气道行BAL治疗。观察对比治疗前及治疗后4 h痰液性状、HR、R、Ppeak、PaO2、氧合指数及术后第一日胸片表现。结果治疗后痰液明显减少变稀薄;HR、R、Pperk下降,PaO2、氧合指数上升,差异具有统计学意义(P<0.05);胸片示肺斑片影减少,部分肺不张肺得以复张。结论纤支镜BAL联合机械通气能有效清除痰液,解除支气管阻塞,改善通气、换气功能,是治疗重症肺部感染并发呼吸衰竭的一种有效、安全的治疗手段。

Objective To investigate the security and clinical value of bronchoalveolar lavage by fiberoptic bronchoscopy （BAL） combined with mechanical ventilation in the treatment of severe pulmonary infection. Methods 55 patients with severe pulmonary infec- tion complicated with respiratory failure were set up artificial airway to give bronchoalveolar lavage. Their sputum character, HR, R, Ppeak, PaO2 , oxygen index and chest radiography of the first postoperative day were observed before and after the treatment. Results After the treatment, the sputum was significantly reduced and became thin. The levels of HR, R, and Pperk decreased, and the levels of PaO2 and oxygenation index increased significantly with statistical significance （P 〈0. 05 ）. Bedside, chest radiography showed pulmonary patch shadow decreased and some patients with pulmonary atelectasis were re-expanded. Conclusion Fiberoptic bronchoscopy bronchoalveolar lavage combined with mechanical ventilation can effectively remove sputum, relieve bronchial obstruction, and improve ventilation function. It is an effective, safe method in the treatment of patients with severe pulmonary infection complicated with respiratory failure. [