纤维支气管镜肺灌洗联合无创正压通气在慢性阻塞性肺疾病合并呼吸衰竭中的应用

Fiberoptic bronchoscopy lung lavage and noninvasive positive pressure ventilation in application of chronic obstructive pulmonary disease with respiratory failure

目的 探讨经纤维支气管镜肺灌洗联合无创正压通气（NIPPV）在慢性阻塞性肺疾病（COPD）合并呼吸衰竭中的应用价值.方法 将50例COPD并呼吸衰竭患者随机分为治疗组26例和对照组24例,对照组患者在内科综合治疗的基础上联合NIPPV治疗,治疗组在对照组的基础上,经鼻插入纤维支气管镜,行纤维支气管镜肺灌洗,2～3天1次,连续2周.结果 两组有创机械通气率分别为15.4％和37.5％、病死率分别为7.7％和16.7％、住院时间分别为（13.8±5.4）和（25.6±17.3）天,差异均有统计学意义（P＜0.05）,治疗组明显低于对照组;治疗2周后PaO2、SaO2、PaCO2及pH值改善程度,治疗组明显优于对照组（P＜0.05）.结论 纤维支气管镜肺灌洗联合NIPPV治疗COPD并呼吸衰竭可改善患者的血气状况,减少有创机械通气率、病死率和住院时间,疗效确切、安全可靠,可在临床推广应用.

Objective To study the effect of bronchoscopy combined noninvasive positive pressure ventilation （NIPPV） on chronic obstructive pulmonary disease （COPD） with respiratory failure. Methods 50 patients with COPD and respiratory failure were randomly divided into treatment group （26 cases） and control group （24 cases）. The control group was treated with the basis of the medicine comprehensive treatment and NIPPV treatment. The treatment group was treated with the nasal insert fiber bronchoscope and fiberoptic bronchoscopy lung lavage. Results The invasive ven- tilation rate, mortality and the length of time of the two groups were statistically different （P〈0.05）, which of treat ment group were obviously lower than that of the control group. PaO2, SaO2, improved PaCO2 and pH value of the treatment group 2 weeks after treatment were significantly better than that of control group （P〈0.05）. Conclusion Fiberoptic hronchoscopy lung lavage and NIPPV can improve blood gas condition of patients with COPD and respiratory failure and reduce the ventilation rate, mortality and hospitalization time.