纤维支气管镜肺泡灌洗联合有创-无创机械通气序贯治疗AECOPD合并Ⅱ型呼吸衰竭的临床效果

Clinical effect of alveolar wash by fiber bronchoscope combined with invasive-noninvasive mechanical ventilation as a sequential therapy on treating acute exacerbation of chronic obstructive pulmonary disease complication with type Ⅱ respiratory failure

目的探讨纤维支气管镜肺泡灌洗联合有创-无创机械通气序贯治疗慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭的临床效果。方法将本院2012年6月~2014年6月收治入院的68例AECOPD合并Ⅱ型呼吸衰竭患者随机分为观察组和对照组各34例,观察组采用纤维支气管镜肺泡灌洗联合有创-无创机械通气序贯治疗,对照组采用有创-无创机械通气序贯治疗。比较两组的临床有效率、呼吸机相关性肺炎（VAP）发生率、住监护室时间、院内死亡率、住院天数及费用等。结果观察组有效率为88.23%,高于对照组的64.71%,差异有统计学意义（P〈0.05）;观察组患者住监护室时间为（12.5±3.5）d、住院天数为（19.5±4.3）d,明显短于对照组的（22.8±5.2）d和（29.6±5.8）d,观察组住院费用为（1.8±0.9）万元,明显低于对照组的（2.5±0.6）万元,差异有统计学意义（P〈0.05）;观察组VAP发生率为2.94%、院内死亡率为2.94%,均显著低于对照组的23.53%和17.65%,差异有统计学意义（P〈0.05）。结论纤维支气管镜肺泡灌洗联合有创-无创机械通气序贯治疗AECOPD合并Ⅱ型呼吸衰竭的临床效果显著,安全性高。

Objective To explore the clinical effect of alveolar wash by fiber bronchoscope combined with invasive-noninvasive mechanical ventilation as a sequential therapy on treating acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complication with type Ⅱ respiratory failure. Methods 68 patients suffered from AECOPD complication with type Ⅱ respiratory failure in our hospital from June 2012 to June 2014 were randomly divided into observation group and control group,34 cases in each group.Alveolar wash by fiber bronchoscope combined with invasive-noninvasive mechanical ventilation as a sequential therapy was adopted to the observation group,while only invasive-noninvasive mechanical ventilation was provided to the control group.The clinical effective rate,incidence of ventilator associated pneumonia（VAP）,time of staying in ICU,hospital mortality,hospital stay,and hospital cost in the two groups was compared. Results The effective rate of the observation group was 88.23%,higher than 64.71% of the control group,the difference was significant（P0.05）.In the observation group,the time of staying in ICU lasted（12.5±3.5） d,the hospital stay was（19.5±4.3） d,lower than（22.8±5.2） d and（29.6±5.8） d of the control group;hospital costs were（1.8±0.9）×10^4yuan in the observation group,（2.5±0.6）×10^4yuan in the control group,the difference was significant（P〈0.05）.The incidence of VAP in the observation group and control group was 2.94% and 23.53% respectively,the hospital mortality was 2.94% and 27.65% in turn,the difference was significant（P〈0.05）. Conclusion Alveolar wash by fiber bronchoscope combined with invasive-noninvasive mechanical ventilation as a sequential therapy on treating AECOPD complication with type Ⅱ respiratory failure can obtain a remarkable clinical effect and with high safety.