支气管肺泡灌洗联合无创正压通气治疗老年重症肺炎并Ⅱ型呼吸衰竭35例

Bronchoalveolar lavage combined with NIPPV in the treatment of 35 elderly patients with severe pneumonia and typeⅡrespiratory failure

目的探究支气管肺泡灌洗联合无创正压通气(NIPPV)对老年重症肺炎并Ⅱ型呼吸衰竭的疗效。方法采用随机对照试验设计,选取2017年10月至2019年10月南京医科大学第四附属医院收治的老年重症肺炎合并Ⅱ型呼吸衰竭病人67例,按照随机数字表法分为观察组35例与对照组32例,均给予常规治疗,对照组同时给予NIPPV,观察组在对照组基础上给予支气管肺泡灌洗治疗,对比两组血气分析指标、氧合指数(PaO_(2)/FiO_(2))、健康状况评分、血清炎性因子、有创机械通气率、住ICU时间及病死率。结果治疗后,两组二氧化碳分压(PaCO_(2))均降低,观察组低于对照组[(48.21±5.18)mmHg比(53.02±7.94)mmHg,P<0.05],血氧饱和度(SaO_(2))、血氧分压(PaO_(2))、PaO_(2)/FiO_(2)均较治疗前升高,观察组SaO_(2)高于对照组[(91.73±8.31)%比(87.06±7.20)%,P<0.05],PaO_(2)、PaO_(2)/FiO_(2)均显著高于对照组(P<0.001);治疗后,两组APACHEⅡ评分均下降,观察组低于对照组[(7.68±1.83)分比(9.12±2.45)分,P<0.05],两组治疗前后比较差异有统计学意义(P<0.001);治疗后两组血清CRP、IL-6均明显下降,且观察组低于对照组,组内及组间比较均差异有统计学意义(P<0.001);观察组有创机械通气率低于对照组,差异有统计学意义(5.71%比28.13%,P<0.05),住ICU时间明显短于对照组[(8.49±3.06)d比(13.87±5.13)d,P<0.001]。观察组与对照组病死率比较,差异无统计学意义(11.43%比18.75%,P>0.05)。结论支气管肺泡灌洗联合NIPPV治疗老年重症肺炎并Ⅱ型呼吸衰竭效果确切,可有效纠正呼吸衰竭症状,减轻机体炎症反应,改善呼吸功能,降低转有创机械通气率,并可在一定程度上缩短住ICU时间,降低病死率。

Objective To explore the effect of bronchoalveolar lavage combined with noninvasive positive pressure ventilation(NIPPV)on elderly patients with severe pneumonia and type Ⅱ respiratory failure.Methods A randomized controlled trial design was used to select 67 elderly patients with severe pneumonia and type Ⅱ respiratory failure who were admitted to The Fourth Affiliated Hospital of Nanjing Medical University from October 2017 to October 2019,and according to the method of random number table,they were assigned into observation group and control group,all patients were given routine treatment,the control group was given NIPPV at the same time,and the observation group was given bronchoalveolar lavage on the basis of the control group.The blood gas analysis index,Oxygenation index(PaO_(2)/FiO_(2)),health status score,serum inflammatory factors,invasive mechanical ventilation,ICU stay time and mortality were compared between the two groups.Results After the treatment,the PaO_(2) of the two groups decreased,PaO_(2) of the observation group was lower than that of the control group[(48.21±5.18)mmHg vs.(53.02±7.94)mmHg,P<0.05],the SaO_(2),PaO_(2) and PaO_(2)/FiO_(2) increased,the SaO_(2) in observation group was higher than that of the control group[(91.73±8.31)%vs.(87.06±7.20)%,P<0.05],the PaO_(2) and PaO_(2)/FiO_(2) were significantly higher than that of the control group(P<0.001);after treatment,the APACHEⅡscores of the two groups decreased,PaO_(2) of of the observation group was lower than that of the control group[(7.68±1.83)vs.(9.12±2.45),P<0.05],and there was a statistical difference between the two groups(P<0.05);after treatment,the serum CRP and IL-6 of the two groups decreased significantly,serum CRP and IL-6 of the observation group were lower than those of the control group,and the difference between the two groups was statistically significant(P<0.001);the invasive mechanical ventilation in the observation group was significantly lower than that in the control group,and the difference was statistically significant(5.71%vs.28.13%,P<0.05),and ICU stay time was significantly higher than that of the control group[(8.49±3.06)d vs.(13.87±5.13)d,P<0.001];the mortality of the observation group was 11.43%,which was lower than that of the control group(18.75%),and there was no significant difference(P>0.05).Conclusion Bronchoalveolar lavage combined with NIPPV is effective in the treatment of elderly patients with severe pneumonia and type Ⅱ respiratory failure.It can effectively correct the symptoms of respiratory failure,reduce the inflammatory response of the body,improve respiratory function and reduce invasive mechanical ventilation,shorten the ICU stay time to a certain extent,and reduce the mortality.