不同途径纤维支气管镜肺泡灌洗在机械通气患者中的比较研究

摘要

ObjectiveTo investigate the effect and safety of comparative study in the different ways of bronchoalveolar lavage(BAL)in the patients with mechanical ventilation.MethodsSeventy-two patients,under tracheotomy tube and mechanical ventilation,were randomly divided into treatment group and control group with 36 cases in each group,They were respectively given sputum suction by bronchoscope and BAL via extratracheal and endotracheal, the data of vital signs and arterial blood gas were recorded and analyzed before,during(5,20minutes),bronchoscopy treatment completed and 1h after bronchoscopy.ResultsHeart rate(HR),blood oxygenous saturation(SaO2),fraction of inspired oxygen(FiO2),peak inspiratory pressure(PIP) in treatment group were significant better during bronchoscopy than those in control group(P<0.05),and the incidence of adverse reaction was lower than in control group(P<0.05),arterial blood gas in two groups at the time 1h after bronchoscopy were improved compared with pre-bronchoscopy(P<0.05),but there was obviously increased in arterial partial pressure of oxygen(PaO2)and decreased in arterial partial pressure of carbon dioxide(PaCO2)in treatment group at the time bronchoscopy treatment comoleted(P<0.05).Conclusion The bronchoscopy via extratracheal tracheotomy tube for sputum suction and BAL were more stable,safe and effective to the patients with mechanical ventilation in ICU.%目的：探讨不同途径纤支镜肺泡灌洗术在机械通气患者中的治疗效果及安全性。方法选取72例在气管切开和机械通气下行纤支镜吸痰和肺泡灌洗术（BAL）患者，随机分为观察组和对照组，每组各36例。分别经导管外和导管内插入纤支镜进行吸痰和BAL，观察比较两组患者纤支镜治疗术前、术中5min、术中20min、术毕及术后1h患者生命体征和血气分析等指标变化。结果观察组患者术中心率（HR）、动脉血氧饱和度（SaO2）、吸入氧浓度（FiO2）、气道峰压（PIP）等指标明显优于对照组（P<0.05），不良反应发生率低于对照组（P<0.05），两组患者术后1h血气分析较术前改善（P<0.05），但观察组患者术毕PaO2水平较术前明显升高，PaCO2明显下降（P<0.05）。结论由气管切开经导管外侧插入纤支镜对ICU机械通气危重患者进行吸痰和BAL，过程更加平稳，操作安全有效。