纤支镜吸痰＋支气管肺泡灌洗在机械通气患者治疗中的应用

目的：探讨纤维支气管镜（简称：纤支镜）吸痰＋支气管肺泡灌洗对机械通气患者的临床疗效。方法：回顾性分析接受机械通气治疗的34例呼吸衰竭患者的临床资料，均给予镇静镇痛、营养支持、抗感染等治疗；治疗组（n=17）行纤支镜吸痰＋支气管肺泡灌洗，对照组（n=17）行常规吸痰。比较两组治疗前后动脉血气分析、机械通气时问、肺部阴影消散时间、ICU住院时间、28d病死率等指标变化。结果：治疗前两组PaO2、PaCO2、SaO2、PaO2／FiO2相比较，差异均无统计学意义（P〉0．05）；治疗后，治疗组PaO2、SaO2、PaO：／FiO2升高和PaCO2下降与对照组比较，差异均有统计学意义（P〈0．05）；治疗组机械通气时间和肺部阴影消散时间短于对照组，差异有统计学意义（P〈0．05），但ICU住院时间和28d病死率差异无统计学意义（P〉0．05）。结论：应用纤支镜吸痰＋支气管肺泡灌洗治疗机械通气患者，可以有效改善氧合和肺内通气，利于肺部炎症控制，但不改变病死率。

Application of Fiberoptic Bronchoscopy with Bronchoalveolar Lavage in Patients with Mechanical Ven- tilation

Objective：To investigate the effect of the fiberoptic bronchoscope suction plus bronchoalve- olar lavage in mechanically ventilated patients. Methods： Retrospective analysis of 34 patients treated with me- chanical ventilation, given the same treatments included analgesic sedation nutritional support and anti -infec- tion; treatment group（ n = 17） was performed with the fiberoptic bronchoscope suction plus bronchoalveolar lav- age, control group （ n = 17） was treated with conventional suction ; the changes of arterial blood gas analysis be- fore and after treatment was compared, and other clinical data such as days of mechanical ventilation, days in ICU,lung shadows dissipation time and 28 d mortality between two groups. Results：Before treatment, PaO2,PaCO2 ,SaO2 ,PaO2/FiO2 had no significant differences （ P 〉 0. 05 ）, after treatment, PaO2, SaO2, PaO2/FiO2 in- creased and PaCO2 decreased compared with the control group, the difference was statistically significant （ P 〈 0. 05 ）, mechanical ventilation time and lung shadows dissipation time in the treatment group were shorter than the con- trol group, there was a significant difference （P 〈0.05） ,but, days in ICU and 28 days mortality differences were not significant（ p 〉 0. 05 ）. Conclusions： Bronchoscopy sputum plus bronchoalveolar lavage in mechanically ventilated patients can effectively improve oxygenation and pulmonary ventilation, and control lung inflammation, but does not reduce mortality.