纤支镜在AECOPD合并严重呼吸衰竭治疗中的价值探讨

Value of Fiberoptic Bronchoscopy in the Treatment of AECOPD Complicated with Severe Respiratory Failure

目的:探析临床治疗慢性阻塞性肺疾病急性加重(AECOPD)合并严重呼吸衰竭应用纤维支气管镜的疗效。方法:选择93例AECOPD合并严重呼吸衰竭患者,患者为某院2015年6月～2017年1月收治,根据不同治疗方案分组,即治疗组(n=53)和对照组(n=40),两组患者均首先接受抗感染治疗,治疗组在纤支镜的引导下进行气管插管、吸痰、支气管肺泡关系后进行有创和无创的序贯机械通气治疗,对照组在喉镜引导下进行气管插管、吸痰、有创无创序贯机械通气治疗,比较两组患者治疗效果。结果:治疗组一次插管成功率和痰培养阳性率明显高于对照组,而病死率和并发症发生率明显低于对照组,两组比较差异有统计学意义(P<0.05);治疗组平均插管时间、呼吸衰竭纠正时间、有创通气时间、PIC出现时间均显著短于对照组,两组比较,差异有统计学意义(P<0.05)。结论:临床治疗AECOPD合并严重呼吸衰竭可在纤支镜的引导下接受气管插管、吸痰、支气管肺泡灌洗、有创/无创及系统器治疗,能够迅速改善患者呼吸功能,提高抢救成功率。

Objective To investigate the effects of fiberoptic bronchoscopy in clinical treatment of chronic obstructive pulmonary disease with acute exacerbation （AECOPD） complicated with severe respiratory failure. Methods： 93 cases of patients with AECOPD complicated with severe respiratory failure accepted treatments in a hospital from June 2015 to January 2017 were selected in this paper,and grouped according to different treatment regimens as the treatment group （ n =53） and the control group （ n =40）.Two groups of patients were treated with anti infection therapy first,the treatment group were treated with invasive and non-invasive sequential mechanical ventilation after tracheal intubation, sputum aspiration and bronchial alveolar relationship under the guidance of fiberoptic bronchoscopy,while the control group was treated with endotracheal intubation, sputum aspiration, invasive and non-invasive sequential mechanical ventilation under the guidance of laryngoscope.Then,the treatment effects of two groups of patients were compared. Results： The success rate of first intubation and sputum culture positive rate in the treatment group were significantly higher than those in the control group, while the mortality and complication rate were significantly lower than those in the control group, the difference between the two groups was statistically significant （ P 〈 0.05 ）.The average intubation time, respiratory failure correction time, invasive ventilation time, PIC time were significantly shorter in the treatment group than in the control group, the difference between the two groups was statistically significant （ P 〈0.05）. Conclusion： The clinical treatment of AECOPD complicated with severe respiratory failure can be treated with tracheal intubation, sputum, bronchoalveolar lavage, invasive/non-invasive and systemic therapy under the guidance of fiberoptic bronchoscopy,which can quickly improve the respiratory function of patients, improve the success rate of rescuing.