纤维支气管镜联合肺泡灌洗术治疗慢性阻塞性肺疾病合并肺不张

Application of fiberoptic bronchoscopy combined with alveolar lavage in elderly patients with chronic obstructive pulmunary disease combined with atelectasis

目的探讨纤维支气管镜联合肺泡灌洗术在慢性阻塞性肺疾病(COPD)合并肺不张中的应用价值。方法回顾分析我院2013年5月至2015年5月老年COPD合并肺不张病人120例,按采取治疗方式不同分为纤维支气管镜治疗组(纤支镜组)60例和无创正压通气治疗组(无创通气组)60例。纤支镜组采取纤维支气管镜联合肺泡灌洗术治疗,无创通气组采取无创呼吸机辅助通气治疗;治疗前与治疗3月后比较2组病人的呼吸困难评分、肺功能指标及动脉血气水平。结果 2组病人治疗3月后MRC呼吸困难指数(m MRC)评分均明显低于治疗前(P<0.05),且纤支镜组病人m MRC评分低于无创通气组(P<0.05);2组用力肺活量(FVC)、第1秒用力呼气容积(FEV1)和第1秒用力呼气容积占预计值百分比(FEV1%)均较治疗前改善,且纤支镜组改善更明显;治疗3月后纤支镜组动脉血氧饱和度(Sa O2)、血氧分压(Pa O2)明显高于无创通气组(P<0.05),血二氧化碳分压(Pa CO2)低于无创通气组(P<0.05)。结论纤维支气管镜联合肺泡灌洗术治疗肺不张操作简单、较易掌握,病人痛苦少,效果显著,具有很好的应用价值,值得临床推广。

Objective To explore the application value of bronchoscopy combined with alveolar lavage in elderly patients with chronic obstructive pulmunary disease（ COPD） combined with atelectasis.Methods A total of 120 cases with COPD combined with atelectasis in our hospital from May 2013 to May 2015 were retrospectively analyzed. According to the different treatment methods,all cases were divided into fiberoptic bronchoscopy group（ bronchoscopy group） and noninvasive positive pressure ventilation treatment group（ noninvasive ventilation group）,with 60 cases in each group. The patients of bronchoscopy group were treated with bronchoscopy combined with alveolar lavage,while the patients in noninvasive ventilation group received non-invasive ventilator assisted ventilation treatment. The dyspnea score,lung function indicators and blood gas analysis were detected and compared between two groups.Results After treatment,the scores of dyspnea and the improvement of lung function in bronchoscopy group were more significant than those in noninvasive ventilation group（ P〈0. 05）; The levels of FVC,FEV1 and FEV1% were inereased after treatment,especially in bronchoscopy group（ P〈0. 05）,The levels of arterial oxygen saturation（ Sa O2） and oxygen pressure（ Pa O2） in bronchoscopy group were higher than those in noninvasive ventilation group（ P〈0. 05）,and the partial pressure of carbon dioxide（ Pa CO2） was significantly lower than that of noninvasive ventilation group（ P〈0. 05）. Conclusions The effect of fiberoptic bronchoscopy combined with alveolar lavage in the treatment for atelectasis is significant,which is worthy of clinical promotion.