CAJ | 학술논문

目的：观察床旁支气管镜技术对治疗COPD合并呼吸衰竭患者的疗效。方法选择COPD 急性加重期（AECOPD）合并呼吸衰竭患者60例，随机分为观察组（28例）和对照组（32例），对照组予常规治疗（吸氧、解痉平喘、止咳化痰、抗感染、无创正压通气等），观察组在前述常规治疗基础上予以床旁纤维支气管镜（纤支镜）吸痰加冲洗，并取痰标本行细菌培养。观察2组在治疗前后的血气变化、无创正压通气时间、成功率、痰标本合格率及阳性率。结果观察组28例中，配合床旁纤支镜治疗成功25例，成功率89％，明显高于对照组的63％（P ＜0．05）。2组治疗后的血气分析指标均比治疗前明显好转，且观察组优于对照组（P 均＜0．05）。观察组痰标本合格率及阳性率均明显高于对照组（96％ vs．75％、79％ vs．53％，P 均＜0．05）。观察组的通气时间及住院时间均比对照组明显缩短（P 均＜0．01）。结论对 AECOPD 无创正压通气患者行经床旁纤支镜吸痰加冲洗可明显改善患者通气功能，且有助于提取合格痰标本，有利于制订更适当的治疗方案，改善预后。
목적：관찰상방지기관경기술대치료COPD합병호흡쇠갈환자적료효。방법선택COPD 급성가중기（AECOPD）합병호흡쇠갈환자60례，수궤분위관찰조（28례）화대조조（32례），대조조여상규치료（흡양、해경평천、지해화담、항감염、무창정압통기등），관찰조재전술상규치료기출상여이상방섬유지기관경（섬지경）흡담가충세，병취담표본행세균배양。관찰2조재치료전후적혈기변화、무창정압통기시간、성공솔、담표본합격솔급양성솔。결과관찰조28례중，배합상방섬지경치료성공25례，성공솔89％，명현고우대조조적63％（P ＜0．05）。2조치료후적혈기분석지표균비치료전명현호전，차관찰조우우대조조（P 균＜0．05）。관찰조담표본합격솔급양성솔균명현고우대조조（96％ vs．75％、79％ vs．53％，P 균＜0．05）。관찰조적통기시간급주원시간균비대조조명현축단（P 균＜0．01）。결론대 AECOPD 무창정압통기환자행경상방섬지경흡담가충세가명현개선환자통기공능，차유조우제취합격담표본，유리우제정경괄당적치료방안，개선예후。
Objective To observe the clinical efficacy of bedside bronchoscopy in the treatment of chronic obstructive pulmonary disease (COPD)complicated with respiratory failure.Methods Sixty cases de-veloping acute exacerbation of COPD (AECOPD)complicated with respiratory failure were randomly assigned into the treatment (n =28)and control groups (n =32).Patients in the control group received routine treat-ment,such as oxygen inhalation,administering antispasmodics,antitussive and expectorant,anti-infection and noninvasive positive pressure ventilation,etc.Beside conventional management,patients in the treatment group underwent bedside bronchoscopy (fiberoptic bronchoscopy).Sputum sample was collected for bacterial culture. Blood gas changes,duration of noninvasive positive pressure ventilation,success rate,qualified and positive rates of sputum samples were observed before and after treatment in both groups.Results Among 28 cases in the treatment group,25 (89%)were recovered by routine therapy combined with bedside bronchoscopy,sig-nificantly higher compared with 63% in the control group (P <0.05).After respective treatment,significant improvement in blood gas levels was noticed in both groups,especially in the treatment group (both P <0.05) .The qualified and positive rates of sputum sampling in the treatment group were 96% and 79%,significantly higher than 75% and 53% in the control group (both P <0.05).The duration of noninvasive positive pressure ventilation and length of hospital stay in the treatment group were considerably shortened compared with those in the control group (both P <0.01 ).Conclusions Application of bedside bronchoscopy significantly improves ventilation,enhances qualified rate of sputum sample and contributes to selection of proper treatment and clini-cal prognosis of AECOPD patients.