摘要
目的研究纤维支气管镜肺泡灌洗联合无创正压通气(non-invasive positive pressure ventilation,NIPPV)对老年慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者血气分析指标及临床疗效的影响。方法将本院2013年12月至2016年12月收治的94例AECOPD合并Ⅱ型呼吸衰竭老年患者随机分为联合组和对照组,每组各47例。对照组患者均给予常规治疗方案和NIPPV治疗,联合组患者在此基础上加用纤维支气管镜肺泡灌洗术,7天为一疗程,两组患者均治疗2个疗程后评价疗效。结果治疗后,两组患者动脉血氧分压(Pa O_2)、动脉血氧饱和度(Sa O_2)、p H及第1秒用力呼气量占预计值百分比(FEV1%预计值)均明显高于本组治疗前(P<0.01),动脉血二氧化碳分压(Pa CO_2)、心率、呼吸频率、收缩压、舒张压及脑钠肽(BNP)水平均明显低于本组治疗前(P<0.01)。治疗后,联合组患者Pa O_2、Sa O_2及FEV1%预计值均明显高于对照组(P<0.01),心率和BNP水平均明显低于对照组(P<0.01)。联合组患者呼吸衰竭控制时间、感染控制时间及住院天数均明显短于对照组(P<0.01)。两组患者死亡率和不良反应发生率无显著差异(P>0.05)。结论 NIPPV联合纤维支气管镜肺泡灌洗可明显改善AECOPD合并Ⅱ型呼吸衰竭老年患者的肺通气功能,缩短住院天数。
ObjectiveTo research the influence of non-invasive positive pressure ventilation （NIPand fiberoptic bronchoalveolar lavage on blood gas analysis indexes and the clinical curative effect foelderly patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） combined type Ⅱ respiratory failure. Method94 elderly patients with AECOPD combined with type Ⅱ respirafailure in our hospital from December 2013 to December 2016 were selected and divided into combinagroup and control group, 47 cases in each group. Control group patients were treated with conventitherapy and NIPPV, combination group patients were treated with fiberoptic bronchoalveolar lavage basethe therapy above. 7 days for 1 course. Both groups patients were treated for 2 courses and evaluated the efiResultAfter treatment, PaO2, SaO2, pH and FEV1% predicted value of the two groups were significahigher than those before treatment （P〈0.01）, and PaCO2, heart rate, respiratory rate, systolic blood presdiastolic blood pressure and brain natriuretic peptide （BNP） level of the two groups were significantly lothan those before treatment （P 〈 0.01）. PaO2, SaO2, pH and FEV1% predicted value of combination gwere significantly higher than those of control group （P〈 0.01）, heart rate and BNP level were significalower than those of control group （P 〈 0.01）. The control time of respiratory failure, the time of infeccontrol and the days of hospitalization in combined group were significantly shorter than those in cotrol group （P 〈 0.01）. There were no significant differences in mortality and adverse reaction rate between the two groups （P 〉 0.05）. ConclusionNIPPV combined with fiberoptic bronchoalveolar lavage can significantly improve the pulmonary ventilation function of elderly patients with AECOPD complicated with type Ⅱ respiratory failure shortening hospital stay.
出处
《中国医学前沿杂志（电子版）》
2017年第11期84-89,共6页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
慢性阻塞性肺疾病急性加重
Ⅱ型呼吸衰竭
纤维支气管镜
无创正压通气
Acute exacerbation of chronic obstructive pulmonary disease
Type Ⅱ respiratory failure
Fiberoptic bronchoscopy
Non-invasive positive pressure ventilation
