邓俊亮 华美香 陈键腾

【摘要】 目的：研究機械通气下纤维支气管镜肺泡灌洗应用在慢性阻塞性肺疾病合并呼吸衰竭患者中的临床效果。方法：将2019年1月-2021年1月于本院行有创机械通气的慢性阻塞性肺疾病合并呼吸衰竭患者90例随机分为对照组、支气管镜吸痰组及支气管肺泡灌洗组，每组30例。对照组给予抗感染治疗，支气管镜吸痰组在基础治疗上给予支气管镜吸痰治疗，支气管肺泡灌洗组在支气管镜吸痰组基础上给予支气管肺泡灌洗治疗。比较三组临床疗效、血气分析、平均住院时间及费用。结果：支气管肺泡灌洗组的疗效优于对照组及支气管镜吸痰组（P<0.05）;治疗后，各组PaO2、SaO2均较治疗前升高，PaCO2较治疗前下降，支气管肺泡灌洗组在缩短住院时间、减少住院费用方面均优于对照组、支气管镜吸痰组（P<0.05）。结论：纤维支气管镜肺泡灌洗治疗慢性阻塞性肺疾病合并呼吸衰竭患者安全可靠，疗效确切，减少住院时间及费用，患者获益，值得推广。

【关键词】 机械通气 慢性阻塞性肺疾病合并呼吸衰竭 支气管肺泡灌洗

Application of Bronchoalveolar Lavage under Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure/DENG Junliang， HUA Meixiang， CHEN Jianteng. //Medical Innovation of China， 2021， 18（33）： -161

[Abstract] Objective： To study the clinical effect of bronchoalveolar lavage under mechanical ventilation in patients with chronic obstructive pulmonary disease complicated with respiratory failure. Method： A total of 90 patients with chronic obstructive pulmonary disease complicated with respiratory failure who underwent invasive mechanical ventilation in our hospital from January 2019 to January 2021 were randomly divided into control group， bronchoscopic sputum suction group and bronchoalveolar lavage group， with 30 cases in each group. The control group was given anti infection treatment， the bronchoscopic sputum suction group was given bronchoscope sputum suction treatment on the basis of treatment， and the bronchoalveolar lavage group was given bronchoalveolar lavage treatment on the basis of bronchoscopic sputum suction group. The clinical efficacy， blood gas analysis， average length of stay and cost of the three groups were compared. Result： The curative effect of bronchoalveolar lavage group was better than that of the control group and bronchoscopic sputum suction group （P<0.05）; after treatment， PaO2 and SaO2 in each group were increased and PaCO2 was decreased compared with before treatment， bronchoalveolar lavage group was superior to control group and bronchoscopic sputum suction group in shortening hospitalization time and reducing hospitalization cost （P<0.05）. Conclusion： Bronchoalveolar lavage under fiberoptic bronchoscope in the treatment of chronic obstructive pulmonary disease complicated with respiratory failure is safe， reliable， effective. It can reduce hospitalization time and cost， benefit patients， it is worth promoting.

[Key words] Mechanical ventilation Chronic obstructive pulmonary disease complicated with respiratory failure Bronchoalveolar lavage

First-author’s address： Xinhui Hospital， Southern Medical University， Jiangmen 529100， China

doi：10.3969/j.issn.1674-4985.2021.33.038

慢性阻塞性肺疾病是一种常见、多发疾病，其患病率和病死率均居高不下;细菌感染引起慢性阻塞性肺疾病急性加重的作用已证实[1]，且部分患者住院时间长、反复使用抗生素、出现耐药、感染迁延不愈，甚至发展为呼吸衰竭，危及生命。对于行气管插管、机械通气的患者，抗生素的使用无可避免，肺炎导致呼吸机依赖患者撤机失败。控制感染是重中之重。……