摘要
目的：探讨无创通气联合支气管肺泡灌洗对COPD合并肺部感染和Ⅱ型呼吸衰竭患者的疗效。方法：50倒不需立即有创机械通气治疗的COPD合并肺部感染和Ⅱ型呼吸衰竭患者，随机分为对照组26例和灌洗组24例。对照组行常规治疗及无创正压通气（NIPPV）；灌洗组在对照组治疗基础上行支气管肺泡灌洗（BAL）。观察两组在治疗前后各项指标变化及疗效。结果：血气分析同组内治疗前后比较差异有统计学意义（P〈0．01），两组间比较差异有显著性（P〈0．01）；第4天灌洗组WBC、中性粒细胞率、CRP水平较对照组明显降低（P〈O．01）；灌洗组细菌培养阳性率及观察第7天X线示胸片炎性病变吸收率均明显高于对照组（P〈0．01）；灌洗组有创通气上机率、住院时间明显低于对照组（P〈0．05），治愈率明显高于对照组（P〈0．05），两组病死率差异无统计学意义（P〉0．05），两组均无严重并发症。结论：对不需立即行持续有创通气治疗的COPD合并肺部感染和Ⅱ型呼吸衰竭患者，无创通气联合BAL治疗较安全，临床疗效确切，值得临床推广应用。
Objective： To investigate the effects of nonninvasive mechanical ventilation combined with bronchoalveolar lavage on patients of COPD with pulmonary infection and type II respiratory failure. Methods.. 50 patients COFD with pulmonary infection and type II respiratory failure who did not need invasive mechanical ventilation immediately were raneornly divided into control group （26 pateints treated with NIPPV and routine therapy） and BAL group （24 patients treated with BAL based on control group）. The changes in the indicators and therapeutic effects were observed between the two groups before and after the tre- ament. Results：Compared in the same group before and after the treatment, there was significant in blood gas analysis （P〈0. 01）, and there was significant difference in blood gas analysis between the two groups（P〈0.01）. The number of peripheral blood leucocytes,the percent of neutrophilie granuloeyte and the level of C--reactive protein in BAL group were lower than those in control group at the forth day （P〈0. 01）. The positive rate of sputum bacteria cultivation in BAL group was higher that in control group （P〈0.01）. Absorption of lung inflammation referred to X--ray on the 7th day in BAL group was better than that in eontrol（P〈0.01）. The rate of invasive mechanical ventilation was significantly lower than that in control group,and the duration of hospital stay in BAL group was shorter（P〈0. 05）. The cure rate in BAL groug was higher than that in control（P〈0. 05）, but there was no statistical difference in the mortality of patients（P〈0.05 ）and there was no severe compolcation in both groups. Coclusioll： As to patient of COPD with pulmonary infection and type II respiratory failure who did not need invasive mechanical ventilation immediately, noninvasive mechanical ventilation combined with bronchoalvcolar lavage is safe, and the clinical therapeutic effect is exact,so it is worthy to spread widely.
出处
《按摩与康复医学》
2011年第20期27-28,共2页
Chinese Manipulation and Rehabilitation Medicine
关键词
机械通气
支气管肺泡灌洗
慢性阻塞性肺疾病
肺部感染
呼吸衰竭
Mechanical ventilation Bronchoalveolar lavage Chronic obstructive pulmonary disease Pulmonary infection Respiratory failure
