支气管镜下肺泡灌洗联合NPPV治疗急性加重期COPD伴发Ⅱ型呼吸衰竭患者的疗效观察

Bronchoscopic alveolar lavage combined with NPPV in the treatment of acuteexacerbation COPD patients with type Ⅱ respiratory failure

目的:探讨支气管镜下肺泡灌洗联合无创正压通气(Noninvasive positive-pressure ventilation,NPPV)治疗急性加重期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)伴发Ⅱ型呼吸衰竭患者的疗效。方法:选择2020年2月至2021年10月在我院接受诊治的急性加重期COPD伴发Ⅱ型呼吸衰竭患者124例,分为肺泡灌洗联合NPPV组和NPPV组(n=62)。NPPV组在常规药物治疗的基础上给予NPPV治疗,肺泡灌洗联合NPPV组在NPPV组治疗基础上给予支气管镜下肺泡灌治疗。治疗期间,记录患者的体温、生命体征恢复时间、症状消失时间及不良反应发生情况;治疗前和治疗2 w后,采用肺功能检测系统测定患者第1秒用力呼气容积(Forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占预计值的百分比(The forced expiratory volume in one second as a percentage of the predicted value,FEV1%prep)、第1秒用力呼气容积与用力肺活量的比值(Forced expiratory volume in one second/forced vital capacity,FEV1/FVC),采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、降钙素原(Procalcitonin,PCT)水平,采用免疫比浊法进行检测前白蛋白(Prealbumin,,PAB)水平,采用DxFLEX流式细胞仪检测患者血清CD4^(^(+))、CD8^(+)细胞水平并计算CD4^(+)/CD8^(+)值。结果:治疗后,肺泡灌洗联合NPPV组体温恢复时间、生命体征恢复时间、症状消失时间均少于NPPV组(P<0.05),FEV1、FEV1%prep、FEV1/FVC、PAB水平、CD4^(+)水平、CD4^(+)/CD8^(+)水平均高于NPPV组(P<0.05),TNF-α水平、PCT水平、CD8^(+)水平均低于NPPV组(P<0.05);肺泡灌洗联合NPPV组不良反应发生率与NPPV组比较,差异无统计学意义(P>0.05)。结论:在NPPV基础上联用支气管镜下肺泡灌洗治疗急性加重期COPD伴发Ⅱ型呼吸衰竭患者进行治疗,可改善患者肺功能和临床症状具有积极作用,可有效改善患者免疫功能,缓解机体炎症反应,效果安全可靠。

Objective:To investigate the efficacy of bronchoscopic alveolar lavage combined with non-invasive positive pressure ventilation(NPPV)in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)with typeⅡrespiratory failure.Methods:A total of 124 patients with acute exacerbation COPD complicated with type II respiratory failure who were treated in our Hospital from February 2020 to October 2021 were selected.According to different treatment schemes,they were divided into alveolar lavage combined with the NPPV group and NPPV group(n=62).The NPPV group was treated with NPPV based on conventional drug treatment,and the alveolar lavage combined with the NPPV group was treated with bronchoscopic alveolar lavage based on the NPPV group.During the treatment,the recovery time of temperature and vital signs,the time of symptom disappearance,and the occurrence of adverse reactions were recorded;before and after 2 weeks of treatment,the forced expiratory volume in one second(FEV1),the forced expiratory volume in one second as a percentage of the predicted value(FEV1%prep),the forced expiratory volume in one second/forced vital capacity(FEV1/FVC),serum levels of tumor necrosis factor-α(TNF-α)and Procalcitonin(PCT)were detected by enzyme-linked immunosorbent assay,the level of albumin(PAB)was detected by immunoturbidimetry,serum levels of CD4^(+)and CD8^(+)cells were detected by DxFLEX flow cytometry,and CD4^(+)/CD8^(+)was calculated.Results:After treatment,the recovery time of temperature and vital signs,symptom disappearance time in the alveolar lavage combined with the NPPV group were less than those in the NPPV group(P<0.05),the FEV1,FEV1%prep,FEV1/FVC,the levels of PAB,CD4^(+)and CD4^(+)/CD8^(+)were higher than those in the NPPV group(P<0.05),the levels of TNF-α,PCT and CD8^(+)were lower than NPPV group(P<0.05).The incidence of adverse reactions had no significant difference between the alveolar lavage combined with the NPPV group and the NPPV group(P>0.05).Conclusion:Bronchoscopic alveolar lavage combined with NPPV can improve pulmonary function and clinical symptoms of patients with acute exacerbation of COPD accompanied by type II respiratory failure.It can effectively improve the immune function of patients and alleviate the inflammatory reaction of the body.The effect is safe and reliable.