CAJ | 학술논문

目的：探究并分析支气管镜肺泡灌洗联合有创-无创机械通气序贯治疗慢性阻塞性肺疾病( COPD)合并呼吸衰竭的临床疗效。方法选取自2011年1月至2013年12月本院收治的100例COPD合并呼吸衰竭患者，按随机数表法将患者分为观察组和对照组，每组各50例。对照组患者采取有创机械通气治疗，观察组患者采取支气管镜肺泡灌洗联合有创-无创序贯机械通气治疗，观察并比较两组患者治疗后的疗效。结果观察组患者呼吸衰竭纠正时间、感染控制窗出现时间、总机械通气时间、住院时间均明显短于对照组患者；切换时间窗后两组患者血气分析各项指标较治疗前明显改变，观察组患者切换时间窗后pH、PaO2明显高于对照组，而PaCO2明显低于对照组，两组差异有显著性(P<0.05)；观察组患者治疗后并发症的总发生率为10%，明显低于对照组(40%)，差异有显著性(P<0.05)。结论支气管镜肺泡灌洗联合序贯机械通气治疗COPD合并呼吸衰竭具有显著的疗效，不仅能有效改善COPD患者的症状、控制感染、缩短住院时间，还能减少呼吸机相关性肺炎等并发症的发生率。
목적：탐구병분석지기관경폐포관세연합유창-무창궤계통기서관치료만성조새성폐질병( COPD)합병호흡쇠갈적림상료효。방법선취자2011년1월지2013년12월본원수치적100례COPD합병호흡쇠갈환자，안수궤수표법장환자분위관찰조화대조조，매조각50례。대조조환자채취유창궤계통기치료，관찰조환자채취지기관경폐포관세연합유창-무창서관궤계통기치료，관찰병비교량조환자치료후적료효。결과관찰조환자호흡쇠갈규정시간、감염공제창출현시간、총궤계통기시간、주원시간균명현단우대조조환자；절환시간창후량조환자혈기분석각항지표교치료전명현개변，관찰조환자절환시간창후pH、PaO2명현고우대조조，이PaCO2명현저우대조조，량조차이유현저성(P<0.05)；관찰조환자치료후병발증적총발생솔위10%，명현저우대조조(40%)，차이유현저성(P<0.05)。결론지기관경폐포관세연합서관궤계통기치료COPD합병호흡쇠갈구유현저적료효，불부능유효개선COPD환자적증상、공제감염、축단주원시간，환능감소호흡궤상관성폐염등병발증적발생솔。
Objective To explore and analyze the clinical efficacy of bronchoalveolar lavage combined with invasive noninvasive mechanical ventilation sequential therapy in the treatment of chronic obstructive pulmonary disease ( COPD) patients with respiratory failure. Method 100 cases of COPD complicated with respiratory failure patients from January 2011 to Decwmber 2013 in our hospital were selected according to the random number table, which were divided into observation group and control group, each group with 50 cases. The patients in control group were treated with invasive mechanical ventilation, while the observation group patients with the bronchoalveolar lavage therapy combined with sequential invasive-noninvasive mechanical ventilation therapy. Curative effect was observed and compared between the two groups after treatment. Result The infection correcting time, the total duration of me-chanical ventilation, duration of hospitalization of patients with respiratory failure were significantly shorter than those of the control group;each index with blood gas analysis in the two groups after switching windows significantly changed,pH, and PaO2 of the observation group patients after switching time window were significantly higher than those of the control group, and the PaCO2 was significantly lower than that of the control group, and the two groups had significant difference(P<0. 05); the overall complication rate of the patients in observation group after treat-ment was 10%, significantly lower than that of the control group (40%),with statistical significance(P<0. 05). Conclusion Bronchoalveolar lavage combined with sequential mechanical ventilation has significant curative effect in the treatment of COPD with respiratory failure, not only can effectively improve the symptoms of the COPD patients, control the infection, shorten the time of hospitalization, but also reduce the incidence of ventilator-associated pneu-monia and other complications rate; therefore it is an effective means of treatment, which is worthy of putting into clinical application.