电子支气管镜联合有创-无创序贯机械通气治疗COPD并呼吸衰竭的效果观察

Observation on effects of electronic bronchoscopy combined with invasive-noninvasive sequential mechanical ventilation in the treatment of COPD with respiratory failure

目的探究电子支气管镜联合有创-无创序贯机械通气在慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者中的治疗效果。方法选取本院2016年1月至2019年1月接诊的112例COPD合并呼吸衰竭患者作为研究对象,按随机数字表法分为两组,每组56例。对照组采用有创-无创序贯机械通气治疗,观察组在对照组基础上采用电子支气管镜介入治疗。比较两组临床疗效及治疗2周后治疗结果[无创通气时间、首次撤机成功率、呼吸机相关性肺炎发生率、慢性阻塞性肺疾病和支气管哮喘生理评分(CAPS)],记录治疗前、治疗2周后血气指标[血二氧化碳分压(PaCO2)、血氧分压(PaO2)、经皮血氧饱和度(SPO2)]、炎症因子[降钙素原(PCT)、超敏C反应蛋白(hs-CRP)]检测结果。结果观察组治疗总有效率显著高于对照组(P<0.05);观察组无创通气时间短于对照组(P<0.05),首次撤机成功率高于对照组(P<0.05),呼吸机相关肺炎发生率、CAPS评分均低于对照组(P<0.05);治疗后,两组各血气指标均高于治疗前(P<0.05),且观察组高于对照组(P<0.05);治疗后,两组炎症因子各水平均低于治疗前,且观察组低于对照组(P<0.05)。结论电子支气管镜、有创-无创序贯机械通气联合治疗方案能改善COPD合并呼吸衰竭患者的肺功能,减轻机体炎症反应,疗效显著,有助于患者预后恢复。

Objective To explore the therapeutic effect of electronic bronchoscopy combined with invasive or noninvasive sequential mechanical ventilation on patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods 112 patients with COPD complicated with respiratory failure admitted to our hospital from January 2016 to January 2019 were selected as research subjects,they were divided into two groups according to the random number table method,with 56 cases in each group.Control group was given invasive-noninvasive sequential mechanical ventilation,and observation group was given electronic bronchoscopy intervention on the basis of control group.The clinical efficacy and the treatment results 2 weeks after treatment[noninvasive ventilation time,first weaning success rate,incidence rate of ventilator-associated pneumonia,COPD and Asthma Physiology Score(CAPS)]were compared between the two groups,and the detection results of blood gas indicators[partial pressure of carbon dioxide(PaCO2),partial pressure of blood oxygen(PaO2),transcutaneous oxygen saturation(SPO2)]and inflammatory factors[procalcitonin(PCT),hypersensitivity C-reactive protein(hs-CRP)]were recorded before treatment and 2 weeks after treatment.Results The total effective rate of clinical treatment in observation group was significantly higher than that in control group(P<0.05).The noninvasive ventilation time of observation group was shorter than that of control group(P<0.05),and the first weaning success rate was higher than that of control group(P<0.05),and the incidence rate of ventilator-associated pneumonia and CAPS score were lower than those of control group(P<0.05).After treatment,the blood gas indicators of the two groups were higher than those before treatment(P<0.05),and the indicators of observation group were higher than those of control group(P<0.05).After treatment,the levels of inflammatory factors in the two groups were lower than those before treatment,and the levels of observation group were lower than those of control group(P<0.05).Conclusion Electronic bronchoscopy combined with invasive-noninvasive sequential mechanical ventilation can improve the lung function and relieve the inflammatoey response of patients with COPD complicated with respiratory failure,and it has better clinical efficacy and is helpful for the prognosis recovery of patients.