电子支气管镜肺泡灌洗联合无创正压通气治疗老年慢性阻塞性肺疾病合并呼吸衰竭患者的效果

Effects of electronic bronchoscope alveolar lavage combined with noninvasive positive pressure ventilation on elderly patients with chronic obstructive pulmonary disease complicated with respiratory failure

目的:观察电子支气管镜肺泡灌洗联合无创正压通气治疗老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的效果。方法:选取2018年4月至2021年11月该院收治的90例老年COPD合并呼吸衰竭患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各45例。两组均进行常规治疗,在此基础上,对照组行无创正压通气治疗,观察组在对照组基础上联合电子支气管镜肺泡灌洗治疗,比较两组无创正压通气时间、住院时间、临床疗效、治疗前后肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、呼气流量峰值(PEF)]水平、炎性指标[C反应蛋白(CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平和并发症发生率。结果:观察组无创正压通气时间、住院时间均短于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率为91.11%(41/45),高于对照组的71.11%(32/45),差异有统计学意义(P<0.05);治疗后,观察组FVC、FEV_(1)、PEF水平均高于对照组,CRP、IL-8、TNF-α水平均低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:电子支气管镜肺泡灌洗联合无创正压通气治疗老年COPD合并呼吸衰竭患者可提高治疗总有效率和肺功能指标水平,缩短无创正压通气时间和住院时间,降低炎性指标水平,效果优于单纯无创正压通气治疗。

Objective:To observe effects of electronic bronchoscope alveolar lavage combined with noninvasive positive pressure ventilation on elderly patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods:A prospective study was conducted on 90 elderly patients with COPD and respiratory failure admitted to the hospital from April 2018 to November 2021.They were divided into observation group and control group according to the random number table method,45 cases in each.Both groups received routine treatment.On this basis,the control group was treated with noninvasive positive pressure ventilation,while the observation group was treated with electronic bronchoscopy alveolar lavage on the basis of that of the control group.The noninvasive ventilation time,the hospitalization time,the clinical efficacy,the lung function index levels[forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),peak expiratory flow(PEF)]before and after the treatment,the inflammatory index levels[C-reactive protein(CRP),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],and the incidence of complications were compared between the two groups.Results:The noninvasive positive pressure ventilation time and the hospitalization time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The total effective rate of treatment in the observation group was 91.11%(41/45),which was higher than 71.11%(32/45)in the control group,and the difference was statistically significant(P<0.05).After the treatment,the levels of FVC,FEV_(1)and PEF in the observation group were higher than those in the control group,the levels of CRP,IL-8 and TNF-αwere lower than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:Electronic bronchoscope alveolar lavage combined with noninvasive positive pressure ventilation in the treatment of the elderly COPD patients with respiratory failure can improve the total effective rate of treatment and the levels of lung function indexes,shorten the noninvasive positive pressure ventilation time and the hospitalization time,and reduce the levels of inflammatory indexes.Moreover,it is superior to single noninvasive positive pressure ventilation.