便携式纤支镜肺泡灌洗治疗呼吸衰竭有创机械通气患者疗效观察

Effect of bronchoalveolar lavage with portable fiberoptic bronchoscopy on treatment of respiratory failure patients undergoing invasive mechanical ventilation

目的研究老年肺部感染致呼吸衰竭患者在有创机械通气期间,行便携式纤支镜肺泡灌洗治疗的临床效果。方法选取2014年1月-2016年6月医院接诊的老年肺部感染致呼吸衰竭患者70例,入院后均实施有创机械通气,给予常规治疗,其中吸痰管负压吸痰35例作为对照组,便携式纤支镜肺泡灌洗35例作为试验组,观察患者治疗前后的血液指标变化,比较治疗恢复时间和吸痰灌洗并发症发生率。结果两组患者治疗前,降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、白细胞计数(WBC)、动脉血氧分压(PaO_2)对比差异不明显,无统计学意义;治疗后PCT、hs-CRP、WBC明显降低、PaO_2明显提高,试验组改善情况优于对照组,差异有统计学意义(P<0.05);试验组呼吸衰竭纠正用时(12.46±3.15)h,有创通气(7.62±1.38)d,住院时间为(10.23±2.74)d,均短于对照组(14.18±2.73)h、(8.65±2.06)d、(12.08±3.66)d,差异有统计学意义(P<0.05);两组吸痰灌洗期间的并发症差异无统计学意义。结论老年肺部感染致呼吸衰竭患者在有创机械通气期间,给予便携式纤支镜肺泡灌洗能够降低PCT、hs-CRP水平,安全高效值得推广。

OBJECTIVE To observe the clinical effect of portable fiberoptic bronchoscopy bronchoalveolar lavage on treatment of elderly patients with respiratory failure induced by pulmonary infections during invasive mechanical ventilation.METHODS A total of 70 elderly patients with respiratory failure induced by pulmonary infections who were treated in the hospital from Jan 2014 to Jun 2016 were enrolled in the study,all of the patients received invasive mechanical ventilation and conventional therapy,35 patients who received negative pressure sputum suction were assigned as the control group,and 35 patients who were treated with portable fiberoptic bronchoscopy bronchoalveolar lavage were set as the observation group.The hematological indexes of the patients were observed before and after the treatment,and the treatment recovery time and incidence of complications induced by sputum suction and lavage were compared.RESULTS There was no significant difference in the procalcitonin（PCT）,highsensitivity C-reactive protein（hs-CRP）,white blood cell（WBC）counts or arterial partial pressure of oxygen（PaO2）between the two groups before the treatment.After the treatment,the levels of PCT,hs-CRP and WBC were significantly reduced,the PaO2 was significantly increased,and there was significant difference between the observation group and the control group（P〈0.05）.The correction time of respiratory failure of the observation group was（12.46±3.15）hours,significantly shorter than（14.18±2.73）hours of the control group;the invasive mechanical ventilation duration of the observation group was（7.62±1.38）days,significantly shorter than（8.65±2.06）days of the control group;the hospitalization duration of the observation group was（10.23±2.74）days,significantly shorter than（12.08±3.66）days of the control group（P〈0.05）.There was no significant difference in the incidence of complications between the wo groups during the sputum suction and lavage.CONCLUSION The portable fiberoptic bronchoscopy bronchoalveolar lavage may reduce the levels of PCT and hs-CRP of the elderly patients with respiratory failure induced by pulmonary infections during the invasive mechanical ventilation,it is safe and effective and is worthy to be promoted.