无创正压通气联合纤维支气管镜肺灌洗治疗老年慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者临床观察

The Clinical Analysis of Non-invasive Positive Pressure Ventilation with Fiberoptic Bronchoscopy Lung Lavage in Elder Patients with AECOPD Combined with TypeⅡ Respiratory Failure

目的探讨无创正压通气(NIPPV)联合纤维支气管镜肺灌洗治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者的效果。方法选取2012年1月至2014年12月在解放军第一〇七医院住院治疗确诊的119例AECOPD合并Ⅱ型呼吸衰竭患者,按照随机数字表法分成观察组(68例)和对照组(51例)。对照组在常规药物治疗基础上采用NIPPV治疗,观察组在对照组治疗的基础上采用纤维支气管镜肺灌洗治疗,对比两组患者的血气指标,心率、呼吸频率等生命体征以及病死率和住院时间。结果观察组治疗后p H、动脉血氧分压(Pa O2)、动脉血氧饱和度(Sa O2)显著高于对照组[(7.41±0.07)比(7.32±0.09),(83±6)mm Hg(1 mm Hg=0.133 k Pa)比(62±9)mm Hg,(92±4)%比(81±5)%,P<0.05],而动脉血二氧化碳分压(Pa CO2)显著低于对照组[(43±5)mm Hg比(68±6)mm Hg,P<0.05]。观察组治疗后的心率、呼吸频率以及收缩压、舒张压显著低于治疗前和对照组[(82±9)次/min比(79±10)次/min,(20±5)次/min比(24±5)次/min,(123±11)mm Hg比(128±9)mm Hg,P<0.05]。观察组住院时间显著短于对照组[(15.4±4.6)d比(22.5±5.7)d],观察组病死率显著低于对照组[5.89%(4/68)比19.61%(10/51)],差异有统计学意义(P<0.05)。结论 NIPPV联合纤维支气管镜肺灌洗治疗AECOPD合并Ⅱ型呼吸衰竭有确切的临床疗效,能改善患者的血气状况,缩短病程。

Objective To investigate the clinical application value of bronchoscopy combined non-invasive positive pressure ventilation（ NIPPV） in elder patients with acute exacerbations of chronic obstructive pulmonary disease（ AECOPD） combined with type Ⅱ respiratory failure. Methods Total of 119 AECOPD patients with type Ⅱ respiratory failure in Chinese PLA 107 th Hospital from Jan. 2012 to Dec. 2014 were divided into observation group（ 68 cases） and control group（ 51 cases） according to random number table method. The control group received conventional treatment plus NIPPV treatment,and the observation group was treated with fiberoptic bronchoscopy lung lavage on the basis of the control group＇s treatment. Results After treatment,the pH value,partial pressure of oxygen（ PaO2）,arterial oxygen saturation（ SaO2） of the observation group were significantly higher than the control group[（ 7. 41 ± 0. 07） vs（ 7. 32 ± 0. 09）,（ 83 ±6） mmHg vs（ 62 ± 9） mmHg,（ 92 ± 4） % vs（ 81 ± 5） %,P〈0. 05 ],Pa CO2 was significantly lower than the control group[（ 43 ± 5） mmHg vs（ 68 ± 6） mmHg,P〈0. 05]. The HR,RR and systolic pressure,diastolic pressure of the observation group were significantly lower than the control group [（ 82 ± 9） times / min vs（ 79 ± 10） times/min,（ 20 ± 5） times/min vs（ 24 ± 5） times/min,（ 123 ± 11） mmHg vs（ 128 ± 9） mmHg,P〈0. 05]. Mean hospital stay of the observation was shorter than the control group[（ 15. 4 ± 4. 6） d vs（ 22. 5 ± 5. 7） d],the mortality was lower than the control group[5. 89%（ 4 /68） vs 19. 61%（ 10 /51） ],the differences were statistically significant（ P〈0. 05）. Conclusion Fiberoptic bronchoscopy lung lavage plus NIPPV can improve blood gas condition of patients with AECOPD combined with type Ⅱ respiratory failure and shorten the disease course.