纤维支气管镜肺灌洗对慢性阻塞性肺疾病急性加重期患者无创正压通气预后的影响

Effect of the fiberoptic bronchoscopy suction and lung lavage treatment on the prognosis of the AECOPD patients under the treatment of the noninvasive positive pressure ventilation

目的探讨纤维支气管镜(FOB)吸引及灌洗治疗对排痰障碍的慢性阻塞性肺疾病急性加重期(AECOPD)患者无创正压通气(NPPV)预后的影响。方法将2012年4月至2014年10月在舞阳县人民医院呼吸内科重症监护室(RICU)住院治疗的79例需要行NPPV治疗且伴有气管内分泌物潴留的AECOPD合并急性呼吸衰竭患者,按照随机原则分为观察组40例和对照组39例,观察组NPPV联合床旁FOB吸引及灌洗治疗,对照组给予NPPV和常规口咽部吸痰,两组其余治疗方案相同。对比观察两组患者生命体征及动脉血气分析等变化,记录气管插管率、入住RICU时间、住院时间和病死率。结果在FOB灌洗治疗前经过NPPV治疗,两组患者各项指标均较前改善,但比较差异均未见统计学意义(P>0.05);观察组FOB灌洗治疗后3 h,心率(HR)、呼吸(RR)、p H值、氧分压(Pa O2)、二氧化碳分压(Pa CO2)、HCO3-与对照组比较差异有统计学意义(P<0.05);FOB灌洗结束24 h,两组各参数间比较差异有统计学意义(P<0.05)。观察组、对照组患者气管插管率分别为17.5%、53.8%,住RICU时间分别为(7±4)d和(11±6)d,住院时间分别为(13±5)d和(18±10)d,病死率分别为7.5%和23.1%。观察组气管插管率较低(P<0.05),住RICU时间及住院时间较短(P均<0.05),病死率较低(P<0.05)。结论纤维支气管镜灌洗治疗可以提高AECOPD排痰障碍患者NPPV治疗成功率,减少气管插管率,降低患者病死率,改善患者预后。

Objective To investigate the effect of the fiberoptic bronchoscopy（FOB）suction and lung lavage treatment on the prognosis of the patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD）under the treatment of the noninvasive positive pressure ventilation（NPPV）. Methods From April 2012 to October 2014,seventy nine AECOPD patients hospitalized in RICU of our hospital with tracheal secretion retention,acute respiratory failure and the need of the NPPV treatment were randomly into two groups：observation group（40 cases）and control group（39 cases）. The treatments of the two groups were same except that the patients in observation group were given NPPV treatment combined with the bedside FOB suction and lung lavage,while patients in control groups were given NPPV treatment combined routine throat sputum suction. The variations of the vital signs and the arterial blood gas analysis,tracheal intubation rate,time of the living in RICU and hospital stay and mortality of the patients were compared between the two groups. Results Under the NPPV treatment,all kinds of items of patients were better than before and there was no significant difference in the items between the two groups before the FOB suction and lung lav-age treatment（P 〉 0. 05）. While 3 h after the FOB suction and lung lavage treatment,there was significant improvement of HR, RR,pH,PaO2 ,PaCO2 ,HCO3 - in patients of the observation group（P 〈 0. 05）,24 h after the FOB suction and lung lavage treatment,there was significant improvement of all kinds of items in patients of the observation group. The tracheal intubation rate of the observation and control group were 17. 5% ,53. 8% ;the time of living in RICU were（7 ± 4）d,（11 ± 6）d,the time of hospital stay were（13 ± 5）d,（18 ± 10）d;the mortality was 7. 5% ,23. 1% in the observation group and control group respec-tively. The differences between the two groups were significant（P 〈 0. 05）. Conclusion FOB suction and lung lavage treatment can improve the success rate of NPPV treatment to the AECOPD patients with difficulty in coughing up phlegm,reduce the rate of tracheal intubation,decrease the mortality,and improve the prognosis.