肺泡灌洗术与纤支镜在慢阻肺合并肺不张中的诊断与治疗研究

The diagnosis and treatment study of alveolar lavage decompression and fiber bronchoscope in chronic obstructive pulmonary disease patients complicated with pulmonary atelectasis

目的探讨肺泡灌洗术与纤维支气管镜在慢性阻塞性肺疾病合并肺不张的临床诊断及治疗中的价值。方法选择80例因感染致慢阻肺合并肺不张接受治疗的患者作为研究对象,其中42例患者进行纤支镜肺泡灌洗术治疗作为试验组,38例患者采用单纯纤支镜吸痰治疗作为对照组,比较两组的正确检出率、血气分析、肺复张及转归情况。结果病原体检测结果显示试验组细菌检出率为100%,对照组细菌检出率为86.84%,两组差异具有统计学意义(P<0.05)。两组患者治疗前后血气分析指标均有明显改善,表现为Pa O2升高,Pa CO2降低,且差异均有统计学意义(P<0.05),但是试验组改变更明显;试验组肺复张率为88.09%,明显高于对照组(P<0.05)。42例试验组总有效率为92.86%,显著高于对照组(72.32%),两组差异具有统计学意义(P<0.05)。结论对于分泌物较多致气道阻塞的慢阻肺合并肺不张患者,及时给予纤支镜吸引和肺泡灌洗,可以迅速通畅气道,使肺不张得以肺复张,加之其有安全有效、技术掌握性强的优势,值得广泛推广。

Objective To explore the value of the clinical diagnosis and treatment of the alveolar lavage operation and fiber bronchoseope in chronic obstructive pulmonary disease patietns complicated with atelectasis. Methods 80 COPD patientscomplicated with atelectasis caused by infection were selected in this study. 42 patients were treat with alveolar lavage with bronchoscopy mirror as the experiment group, and 38 patients were treated with pure fiber bronchoscope sputum suction as the control group. The correct detection rate, blood gas analysis, lung recruitment and disease outcome were compared. Results The pathogen detection results show that the bacteria detection rate in the experiment group was 100% , while the control bacteria detection rate was 86.84% （ P 〈 0. 05 ）. The blood gas analysis indexes in the two groups were obviously improved after the treatment （ P 〈 0. 05 ）, and the improvement was more pronounced in the experiment group than in the control group. The pulmonary recruitment rate in the experiment group was 88. 09% , which was significantly higher than that in the control group （P 〈0. 05）. The total effective rate in the treatment group was 92. 86% , significantly higher than that in the control group （72. 32% ） （P 〈 0. 05 ）. Conclusion For COPD patients complicated with atelectasis secretion and airway obstruction. Timely bronchoscopy suction and alveolar lavage can unobstructe airway and promote recruitment maneuvers, with its advan- tages of safe and effective, and easy mastered technology.