BAL 联合 NIPPV治疗 COPD合并Ⅱ型呼吸衰竭临床观察

摘要

目的：探讨支气管肺泡灌洗（BAL）联合无创正压通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）合并II型呼吸衰竭的临床效果。方法：选取我中心2011年1月至2013年1月间出诊送到同一家医院且收治的COPD合并II型呼吸衰竭的患者86例，随机分为观察组与对照组，观察组在常规治疗的基础上应用BAL联合NIPPV 治疗，对照组单独采用NIPPV 治疗，对比两组患者血气指标、心率、平均动脉压、APACHE II评分变化及不良反应发生情况。结果：两组患者治疗后PaCO2均较治疗前显著下降，治疗前后比较差异有统计学意义（P＜0．05）；观察组患者治疗后PaCO2下降较对照组更加迅速，组间比较差异有统计学意义（ P＜0．05）；且观察组患者在治疗后24h、48h PaO2均显著高于对照组，组间比较差异有统计学意义（ P＜0．05）；且观察组患者气管插管率显著低于对照组，组间比较差异有统计学意义（ P＜0．05）；两组患者心率、平均动脉压治疗24h后比较无统计学差异（ P＞0．05）。结论：BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭能有效的降低患者PaCO2，提高PaO2，可迅速缓解患者呼吸衰竭症状，是治疗COPD合并II型呼吸衰竭的有效治疗方案。%Objective:To investigate the effect of bronchoalveolar lavage ( BAL ) joint non-invasive positive pressure ventilation (NIPPV) in treatment of chronic obstructive pulmonary disease (COPD) com-bined with typeⅡrespiratory failure. Method:A total of 106 patients with COPD combined with type Ⅱre-spiratory failure admitted in our hospital from Jan. 2011 to Jan. 2013 were randomly divided into observation group and control group. Observation group was treated with BAL on the basis of NIPPV treatment, control group adopted NIPPV treatment alone, compared two groups of patients with blood gas index, heart rate, breathing rate, APACHE II score changes and adverse reactions occurrence. Result:After treatment, PaCO2 in two groups was decreased with statistically significant difference (P<0. 05); PaCO2 in observation group declined more rapidly than the control group (P<0. 05), and PaO2 in observation group after the treatment of 24 hours and 48 h were significantly higher than that of control group ( P<0. 05), tracheal intubation rate in observation group was significantly lower than that of control group ( P<0. 05);There were no statistical differences of heart rate, mean arterial pressure, score after treatment of 24 hours between the two groups of patients ( P>0. 05). Conclusion:Therapy of the BAL joint NIPPV in treating COPD combined with type Ⅱrespiratory failure can more effectively reduce PaCO 2, improve PaO2, can rapidly alleviate symptoms of pa-tients with respiratory failure, so this is an effective therapy in the treatment of COPD with type II respiratory failure. Objective:To investigate the effect of bronchoalveolar lavage ( BAL ) joint non-invasive positive pressure ventilation (NIPPV) in treatment of chronic obstructive pulmonary disease (COPD) com-bined with typeⅡrespiratory failure. Method:A total of 106 patients with COPD combined with type Ⅱre-spiratory failure admitted in our hospital from Jan. 2011 to Jan. 2013 were randomly divided into observation group and control group. Observation group was treated with BAL on the basis of NIPPV treatment, control group adopted NIPPV treatment alone, compared two groups of patients with blood gas index, heart rate, breathing rate, APACHE II score changes and adverse reactions occurrence. Result:After treatment, PaCO2 in two groups was decreased with statistically significant difference (P<0. 05); PaCO2 in observation group declined more rapidly than the control group (P<0. 05), and PaO2 in observation group after the treatment of 24 hours and 48 h were significantly higher than that of control group ( P<0. 05), tracheal intubation rate in observation group was significantly lower than that of control group ( P<0. 05);There were no statistical differences of heart rate, mean arterial pressure, score after treatment of 24 hours between the two groups of patients ( P>0. 05). Conclusion:Therapy of the BAL joint NIPPV in treating COPD combined with type Ⅱrespiratory failure can more effectively reduce PaCO 2, improve PaO2, can rapidly alleviate symptoms of pa-tients with respiratory failure, so this is an effective therapy in the treatment of COPD with type II respiratory failure.