俯卧位通气联合纤维支气管镜肺泡灌洗在ICU重型颅脑损伤术后肺不张中的应用效果

Application efficacy of ventilation in prone position combined with fiberbronchoscopic bronchoalveolar lavage for pulmonary atelectasis in postoperative ICU patients with severe craniocerebral injury

目的探讨俯卧位通气联合纤维支气管镜(纤支镜)肺泡灌洗在ICU重型颅脑损伤术后肺不张中的应用效果。方法选取40例肺不张的重型颅脑损伤术后患者,按随机数字表法分成观察组和对照组,每组20例。观察组患者采用俯卧位通气联合纤支镜肺泡灌洗进行肺复张,对照组患者采用纤支镜肺泡灌洗联合呼气末正压(PEEP)递增法进行肺复张。比较两组患者治疗前后肺不张面积、PaO 2、PaCO 2、氧合指数。结果两组患者治疗后PaO 2及氧合指数均高于治疗前,肺不张面积均小于治疗前,且观察组PaO 2、氧合指数及肺不张面积改善均优于对照组(均P<0.05);两组治疗后的PaCO 2均低于治疗前(均P<0.05),但两组治疗后PaCO 2差异无统计学意义(P>0.05)。结论相较于纤支镜肺泡灌洗联合PEEP递增法,俯卧位通气联合纤支镜肺泡灌洗治疗重型颅脑损伤术后肺不张的效果更好,能更好地提高PaO 2和氧合指数。

Objective To explore the application efficacy of ventilation in prone position combined with fiberbronchoscopic bronchoalveolar lavage for pulmonary atelectasis in postoperative ICU patients with severe craniocerebral injury.Methods Forty postoperative pulmonary atelectasis patients with severe craniocerebral injury were divided into observation group and control group according to the method of random number table,with 20 cases in each group.Patients in the observation group underwent ventilation in prone position combined with fiberbronchoscopic bronchoalveolar lavage for lung recruitment,while patients in the control group underwent fiberbronchoscopic bronchia alveolar lavage combined with positive end expiratory pressure(PEEP)increasing method for lung recruitment.Atelectasis area,PaO 2,PaCO 2,and oxygenation index were compared between the two groups before and after treatment.Results After treatment,PaO 2 and oxygenation index were increased and atelectasis area was decreased in both groups as compared with those before treatment,and the observation group was superior to the control group in PaO 2,oxygenation index and atelectasis area(all P<0.05);post-treatment PaCO 2 was lower than pre-treatment PaCO 2 in both groups(all P<0.05),but there was no statistically significant difference in PaCO 2 between the two groups after treatment(P>0.05).Conclusion Compared with fiberbronchoscopic bronchoalveolar lavage combined with PEEP increasing method,ventilation in prone position combined with fiberbronchoscopic bronchoalveolar lavage achieves better efficacy for postoperative pulmonary atelectasis in severe craniocerebral injury and can improve PaO 2 and oxygenation index much better.