AECOPD并Ⅱ型呼吸衰竭患者无创正压通气时行支气管肺泡灌洗的安全性研究

Study on the safety of bronchoalveolar lavage in patients with AECOPD and type Ⅱ respiratory failure during non-invasive positive pressure ventilation

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）并Ⅱ型呼吸衰竭患者在应用无创正压通气（NIPPV）时行支气管肺泡灌洗（BAL）治疗的安全性。方法选取哈尔滨医科大学附属第四医院2016年1月至2017年4月间收治的AECOPD合并Ⅱ型呼吸衰竭的患者80例。随机分为治疗组与对照组，每组各40例。2组在常规治疗基础上均给予NIPPV治疗，治疗组在NIPPV的同时给予BAL治疗。对比2组患者BAL治疗前和治疗后30min、1h及2h动脉血气分析指标、心率、平均动脉压变化及不良反应发生情况。结果2组各时间点心率、平均动脉压比较，差异均无统计学意义（P值均〉0．05）。治疗组治疗后各时间点动脉血氧分压较对照组显著升高（P值均〈0．05），动脉血二氧化碳分压较对照组显著降低（P值均〈0．05）。治疗组不良反应共24例，其中腹胀9例，口鼻干燥11例，心律失常4例；对照组不良反应共21例，其中腹胀10例，口鼻干燥8例，心律失常3例。2组不良反应情况比较，差异无统计学意义（P〉0．05）。结论AECOPD并Ⅱ型呼吸衰竭患者NIPPV治疗时行BAL安全性好，能显著改善患者通气功能。

Objective To investigate the safety of bronchoalveolar lavage （BAL） in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and type Ⅱ respiratory failure patients during mon-invasive positive pressure ventilation （NIPPV）. Methods 80 patients with AECOPD combined with type Ⅱ respiratory failure admitted between January 2016 and April 2017 in the Fourth Affiliated Hospital of Harbin Medical University were randomly divided into treatment group and control group, 40 cases in each group. The two groups were given NIPPV on the basis of routine treatment. The treatment group was given BAL at the same time as NIPPV treatment. The blood gas indexes, heart rate, changes in mean arterial pressure, and incidence of adverse reactions were compared between the two groups before given BAL and after 30 min, 1 h, 2 h. Results There was no significant difference in heart rate and mean arterial pressure between the two groups at each time （all P 〉 0.05）. Arterial partial pressure of oxygen values in the observation group were significantly higher than those in the control group at each time （all P 〈0.05） ; Arterial partial pressure of carbon dioxide decreased significantly compared with the control group, and the difference between the two groups was statistically significant （all P 〈0.05）. There were 24 cases of adverse reactions in the observation group, including nine cases of abdominal distension, 11 cases of oral and nasal dryness, and four cases of arrhythmia;there were 21 cases of adverse reactions in the control group, including 10 cases of abdominal distention, eight cases of oral and nasal dryness, and three cases of arrhythmia. There was no significant difference in the incidence of adverse reactions between the two groups （ P 〉0.05）.Conclusions The safety of BAI. lavage during the NIPPV of patients with AECOPD and type Ⅱ respiratory failure is good, and the improvement of ventilation function is more significant.