纤维支气管镜肺灌洗+BiPAP呼吸机对AECOPD合并Ⅱ型呼吸衰竭患者肺功能及动脉血气指标改善的影响

Effect of fiberoptic bronchoscope lung lavage+BiPAP ventilator on the improvement of pulmonary function and arterial blood gas indexes in patients with AECOPD and typeⅡrespiratory failure

目的:探究纤维支气管镜肺灌洗+双水平无创正压机械通气(BiPAP)呼吸机对慢阻肺急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者肺功能及动脉血气指标改善的影响。方法:选取2018年12月~2019年12月本院收治的AECOPD合并Ⅱ型呼吸衰竭患者86例,随机数字表分为呼吸机组(n=43)、联合组(n=43)。呼吸机组给予BiPAP呼吸机治疗,联合组给予纤维支气管镜肺灌洗+BiPAP呼吸机治疗。比较两组的疗效及治疗前后肺功能指标[第1秒呼气量(FEV1)、用力肺活量(FVC)]、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、血清炎症因子[S100A8/A9、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)]水平。结果:联合组总有效率高于呼吸机组(P<0.05);治疗2周后联合组PaO_(2)高于呼吸机组,PaCO_(2)低于呼吸机组(P<0.05);治疗2周后联合组FEV1、FVC高于呼吸机组(P<0.05);治疗2周后联合组血清S100A8/A9、TNF-α、CRP水平低于呼吸机组(P<0.05)。结论:纤维支气管镜肺灌洗+BiPAP呼吸机治疗AECOPD合并Ⅱ型呼吸衰竭患者,可降低血清S100A8/A9、TNF-α、CRP水平,改善肺功能及动脉血气指标,疗效显著。

Objective:To explore the effect of fiberoptic bronchoscopy lung lavage+bilevel non-invasive positive pressure mechanical ventilation(BiPAP)ventilator on the improvement of lung function and arterial blood gas indexes in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and type Ⅱ respiratory failure.Methods:A total of 86 patients with AECOPD combined with type Ⅱ respiratory failure admitted to our hospital from December 2018 to December 2019 were selected.The random number table was divided into a breathing unit(n=43)and a combined group(n=43).The breathing unit was treated with BiPAP ventilator,and the combined group was treated with fiberoptic bronchoscope lung lavage+BiPAP ventilator.The efficacy and lung function indexes before and after treatment were compared between the two groups[expiratory volume in 1 second(FEV1),forced vital capacity(FVC)],blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],Serum inflammatory factors[S100A8/A9,tumor necrosis factorα(TNF-α),C-reactive protein(CRP)]levels.Results:The total effective rate of the combined group was higher than that of the breathing machine unit(P<0.05);PaO_(2) of the combined group was higher than that of the breathing machine unit and PaCO_(2) was lower than that of the breathing machine group after 2 weeks of treatment(P<0.05);FEV1 and FVC of the combined group were higher than that of the combined group after 2 weeks of treatment Breathing machine(P<0.05);After 2 weeks of treatment,the serum S100A8/A9,TNF-α,CRP levels in the combined group were lower than those of the breathing machine(P<0.05).Conclusion:Fibrobronchoscope lung lavage+BiPAP ventilator can reduce serum S100A8/A9,TNF-α,CRP levels in patients with AECOPD combined with typeⅡrespiratory failure,and improve lung function and arterial blood gas indexes.The effect is significant.