无创正压通气联合纤维支气管镜检查治疗慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭的安全性和有效性分析

Safety and Efficacy of Non-invasive Positive Pressure Ventilation Treatment Combined with Fiberoptic Bronchoscopy on AECOPD Patients with Acute Respiratory Failure

目的评价无创正压通气(NIPPV)联合纤维支气管镜(FB)检查治疗慢性阻塞性肺疾病(简称慢阻肺)急性加重合并Ⅱ型呼吸衰竭的安全性和有效性。方法前瞻病例对照研究。纳入2010年2月至2011年2月在第四军医大学唐都医院呼吸内科重症监护室住院治疗的慢阻肺急性加重合并Ⅱ型呼吸衰竭患者,按照随机原则分为病例组和对照组,病例组均在NIPPV治疗1 h后床旁行FB检查及灌洗治疗,对照组给予NIPPV,两组其余治疗方案相同。对比观察两组患者的生命体征、血气分析、治疗效果及并发症。结果 (1)共有51例患者入选,其中病例组25例,对照组组26例,两组基线各变量比较差异均无统计学意义(P>0.05)。(2)在FB检查前经过NIPPV 1 h治疗,两组各项指标均较入院时改善,但两组间各指标比较差异均无统计学意义(P>0.05)。(3)病例组患者在FB检查过程中心率(HR)较对照组明显增快(P<0.05),其余各指标两组间比较差异无统计学意义(P>0.05)。(4)病例组在FB检查结束后继续NIPPV治疗1 h,HR、呼吸频率、pH、PaO2、PaCO2在两组间比较差异有统计学意义(P<0.05);FB检查结束24 h,两组各参数间比较差异有统计学意义(P<0.05)。(5)两组痰培养阳性率分别为病例组88.0%(22/25),对照组58.6%(14/26),病例组病原菌分离阳性率显著高于对照组(P<0.05)。(6)治疗成功率病例组均优于对照组(P<0.05);病例组治疗失败、死亡及放弃的例数均低于对照组;两组并发症比较差异无统计学意义(P>0.05),均未出现治疗因素导致心脏骤停、大咯血、窒息等严重并发症。结论应用NIPPV联合早期FB检查和治疗慢阻肺急性加重合并Ⅱ型呼吸衰竭的患者是安全、有效和可行的措施之一,值得临床推荐。

Objective To evaluate the safety and efficacy of non-invasive positive pressure ventilation（ NIPPV） combined with fiberoptic bronchoscopy（ FB） on acute exacerbation of chronic obstructive puhmonary disease（ AECOPD） patients with acute respiratory failure. Methods A prospective study was conducted on the AECOPD patients with respiratory failure in respiratory intensive care unit of Tangdu Hospital of Fourth Military Medicine University from February 2010 to February 2011. They were randomly divided into a case group and a control group. The case group was administrated FB and lavage after one hour of NIPPV treatment. The control group was administrated NIPPV without FB and lavage. Other treatment regimen was the same in two groups. Results There were 51 subjects recruited in the study,25 subjects in the case group and 26 subjects in the control group. All variables at baseline were matched（ P 〉0. 05）. All variables improved after one hour of NIPPV before FB,without significant difference between two groups（ P 〉 0. 05）. During the period of FB,heart rate in the case group was faster than that in the control group（ P 〈 0. 05）,and other variables were not significantly different between two groups（ P 〉 0. 05）. Both groups received NIPPV for one hour after FB,the variables including heart rate,respiratory rate,pH,PaO2,PaCO2 were statistically significant between two groups（ P 〈 0. 05）. At the time of 24 hours after FB,the variables including mean arterial pressure,heart rate,respiratory rate,pH,PaO2 and PaCO2in the case group were nearly recovered,and differences between two groups were significant（ P 〈 0. 05）. The positive rate of sputum culture was significantly higher in the case group than that in the control group [88. 0%（ 22 /25） vs.58. 6%（ 14 /26） ]. Success rate in the case group were obviously superior to that in control group. The cases of failure,death and refusing in the case group were lower than those in the control group. Complications in two groups had no significant difference（ P 〉 0. 05）. There was not serious complication such as hear arrest,hemoptysis and apnea during the process of NIPPV combined with early FB. Conclusion It deserves to be used in clinic because of the safety,efficacy and feasible for most of AECOPD patients through NIPPV combined with early FB.