纤维支气管镜对机械通气治疗COPD并呼吸衰竭的效果及并发症的影响

The influence of effect and Complication of Bronchoscopy on the Mechanical ventilation in the treatment of COPD patients with respiratory failure

目的：观察纤维支气管镜对慢性阻塞性肺疾病（ COPD）并呼吸衰竭机械通气治疗的效果及相关并发症的影响，指导临床合理治疗，改善临床预后。方法将本院2012－01～2014－06收治的60例COPD合并呼吸衰竭患者按治疗方法不同分为观察组30例和对照组30例，两组均进行常规方法治疗，包括使用抗菌药物、解痉平喘、镇咳祛痰及纠正酸碱失衡等；对照组患者治疗初期给予机械通气，观察组在对照组的基础上给予纤维支气管镜吸痰、肺泡灌洗及局部病灶给药处理。比较两组患者治疗前、治疗即刻、治疗后4 h血气及血氧饱和度（ SaO2）变化情况，记录机械通气时间及住院时间，比较首次撤机成功率、呼吸机相关性肺炎（ VAP）发生率、VAP治愈时间，评价两组临床疗效。结果观察组和对照组治疗后4 h的PaO2、PaCO2及SaO2均较治疗前明显改善，且观察组治疗即刻PaO2较治疗前明显改善，观察组治疗后4 h PaO2、PaCO2及SaO2较对照组改善更为明显。观察组机械通气时间及住院时间较对照组明显缩短，首次撤机成功率明显提高，VAP发生率有效降低，且VAP患者治愈时间明显缩短。观察组的总有效率为83.33％，对照组为40．00％，观察组的总有效率明显高于对照组（χ2＝12．207，P＜0．01）。结论纤维支气管镜对机械通气治疗COPD并呼吸衰竭的治疗疗效具有积极影响，能够直接解除呼吸道的阻塞及控制局部感染，缩短机械通气通气时间，有效预防或降低VAP的发生，值得临床推广使用。

Objective To observe the clinical efficacy of bronchoscopy on the mechanical ventilation in the treatment of COPD patients with respiratory failure and the influence on the complications of this disease .M ethods Sixty COPD patients with respiratory failure from January 2012 to June 2014 in our hospital were divided into 30 cases of observation group and 30 cases of control group according to different treatment.Both groups were given conventional therapy, including antibiotics, antispasmodic, antitussive and expectorant, correct acid-base balance.The control group were given mechanical ventilation therapy when early disease, the observation group were given suctioning, lavage and local lesions administration by bronchoscopy on the basis of the control group, compared blood gas and oxygen saturation between before treatment, therapy and treatment after 4 h, recorded the time of mechanical ventilation and hospital stay,compared the first weaning success rates, VAP incidence, VAP healing time, evaluated clinical efficacy.Results The PaO2、PaCO2、SaO2 of observation group and control group after treatment 4 h were significant better improvement than before treatment, the PaO2、PaCO2、SaO2 of the observation group after treatment 4 h were significant better improvement than the control group.The time of mechanical ventilation and hospital stay of the observation group were＆amp;nbsp;significant shorter than the control group, the first weaning success rates increased significantly,the rate of VAP effectively reduced, and the healing time of VAP were also significantly shorten.The total effective rate of the observation group were 83.33%, the control group were 40.00%, there were a statistically significant difference （χ^2 =12.207, P 〈0.01 ） .Conclusion The bronchoscopy has a positive impact on mechanical ventilation in the treatment of COPD patients with respiratory failure, can directly relieve airway obstruction and control local infection,shorter the time of mechanical ventilation, effectively preventing or reducing the occurrence of ventilator -associated pneumonia, is worthy of clinical use.