纤维支气管镜肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的临床疗效及安全性研究

Clinical Effect and Safety of Bronchofibroscope-guided Bronchoalveolar Lavage Combined with Non-invasive Positive Pressure Ventilationon on Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with Type Ⅱ Respiratory Failure

目的探讨纤维支气管镜肺泡灌洗联合无创正压通气(NIPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭的临床疗效及安全性。方法选取2013年1月—2014年10月于达州市中心医院呼吸内科和重症医学科住院治疗的AECOPD合并Ⅱ型呼吸衰竭患者92例,采用随机数字表法分为观察组和对照组,各46例。对照组患者给予常规治疗及NIPPV治疗,观察组患者在对照组治疗基础上加用纤维支气管镜肺泡灌洗。比较两组患者治疗14 d后临床疗效及治疗前和治疗14 d后动脉血气指标〔动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)〕,记录两组患者抗菌药静脉滴注时间、住院时间、住院费用及不良反应发生情况。结果观察组患者临床疗效优于对照组(P<0.05)。治疗前两组患者Pa O2和Pa CO2比较,差异无统计学意义(P>0.05);治疗后观察组患者Pa O2高于对照组,Pa CO2低于对照组(P<0.05)。观察组患者抗菌药静脉滴注时间和住院时间短于对照组,住院费用少于对照组(P<0.05)。观察组患者不良反应发生率为15.2%,对照组为10.9%,差异无统计学意义(P>0.05)。结论纤维支气管镜肺泡灌洗联合NIPPV治疗AECOPD合并Ⅱ型呼吸衰竭安全有效,能明显改善患者通气功能、缩短抗菌药使用时间和住院时间,降低住院费用。

Objective To investigate the clinical effect and safety of bronchofibroscope - guided bronchoalveolar lavage combined with non - invasive positive pressure ventilation （ NIPPV ） on acute exacerbation of chronic obstructive pulmonary disease（AECOPD）complicated with typeⅡrespiratory failure. Methods From January 2013 to October 2014,a total of 92 AECOPD inpatients complicated with type Ⅱ respiratory failure were selected in the Department of Respiratory Medicine and ICU,the Central Hospital of Dazhou,and they were divided into observation group and control group according to random number table,46 cases in each. Patients of control group were given conventional treatment and NIPPV,while patients of observation group were given extra bronchofibroscope - guided bronchoalveolar lavage based on the treatment of control group. Clinical effect after 14 day of treatment,PaO2 and PaCO2 before and after 14 day of treatment were compared between the two groups,while antibacterial agentsusing time,hospitalization stays,hospitalization costs and incidence of adverse reactions were recorded. Results The clinical effect of observation group was statistically significantly better than that of control group（ P﹤0. 05）. No statistically significant differences of PaO2 or PaCO2 was found between the two groups before treatment（ P ﹥0. 05）;PaO2 of observation group was statistically significantly higher than that of control group after treatment,while PaCO2 of observation group was statistically significantly lower than that of control group after treatment（P﹤0. 05）. Antibacterial agents using time and hospitalization stays of observation group were statistically significantly shorter than those of control group,and hospitalization costs of observation group was statistically significantly less than that of control group（P﹤0. 05）. The incidence of adverse reactions of observation group was 15. 2%, that of control group was 10. 9%, the difference was not statistically significantly different（ P﹥0. 05 ）. Conclusion Bronchofibroscope -guided bronchoalveolar lavage combined with NIPPV is effective and safe in treating AECOPD complicated with type Ⅱ respiratory failure,which can effectively improve the respiratory function,shorten the antibacterial agents using time and hospitalization stays,reduce the hospitalization costs.