床旁纤支镜气管肺泡灌洗在急诊重症监护室机械通气COPD患者救治中的应用

Application of bedside bronchoscopy BAL in the treatment of ICU patients with mechanical ventilation COPD

目的:探讨床旁纤维支气管镜支气管肺泡灌洗(BAL)在急诊重症监护室(EICU)机械通气慢性阻塞性肺疾病(COPD)患者救治中的应用效果。方法:选取2015-09-2016-07我院EICU收治的86例实施有创机械通气治疗的COPD患者采用随机数字表法分为试验组和对照组各43例,2组均行常规吸痰、抗感染等治疗,试验组同时给予床旁纤维支气管镜BAL治疗,对比2组治疗效果。结果:治疗前,试验组和对照组的PaO_2、PaCO_2、pH值、SaO2、CRP、WBC水平差异无统计学意义。治疗96h后,试验组的PaO_2、pH值、SaO2水平高于对照组,差异有统计学意义(P<0.05);PaCO_2、CRP、WBC水平均低于对照组,差异有统计学意义(P<0.05)。试验组的机械通气治疗时间、ICU治疗时间均显著的低于对照组,差异有统计学意义(P<0.05);试验组的院内死亡率(2.33%)与对照组的院内死亡率(6.98%)比较差异无统计学意义。结论:床旁纤维支气管镜BAL在ICU机械通气COPD患者治疗中有利于进一步改善患者的血气指标、减轻炎症反应、缩短治疗时间。

Objective：To investigate the effect of bedside bronchoscopy bronchoalveolar lavage（BAL）in the treatment of patients with chronic obstructive pulmonary disease（COPD）mechanical ventilation in intensive care unit（ICU）.Method：From ICU in our hospital treated 86 cases of invasive mechanical ventilation in the treatment of COPD patients were randomly divided into experimental group and control group with 43 cases in each group,two groups were treated with conventional sputum and anti infection treatment,the test group was given bedside bronchoscopy BAL treatment,were compared between the two groups effect of treatment.Result：Before treatment,the test group and the control group PaO2,PaCO2,pH,SaO2,CRP,WBC value of the level of the difference was not statistically significant.96 hafter treatment,the test group PaO2,pH,SaO2 levels higher than the control group,the differences were statistically significant（P〈0.05）,PaCO2,CRP,WBC were lower than the control group,the differences were statistically significant（P〈0.05）.Experimental group,mechanical ventilation time,ICU treatment time were significantly lower than the control group,the differences were statistically significant（P〈0.05）;the mortality rate was 6.98% of the difference between the experimental group and the control group of 2.33% hospital mortality in hospital was not statistically significant.Conclusion：BAL mechanical ventilation in patients with ICU mechanical ventilation in the treatment of COPD mechanical ventilation can improve the blood gas indexes,reduce the inflammatory reaction and shorten the treatment time.