机械通气联合支气管肺泡灌洗治疗重症哮喘

目的探讨机械通气必要时联合支气管肺泡灌洗（BAL）在治疗重症哮喘中的作用。方法选择常规治疗后病情缓解不明显的重症哮喘呼吸衰竭患者18例，建立人工气道行机械通气治疗，对24h后气道压力仍偏高者，应用生理盐水经纤支镜行BAL，清除呼吸道痰栓。结果通气24h后，13例气道阻力逐渐下降；另5例PIP仍在55cmH2O以上，行BAL2、24h后，PaO2逐渐升高，PaCO2、PIP逐渐下降，差异有统计学意义（P〈0．05）；12例成功脱机，脱机后血气分析结果恢复正常，pH、PaO2和PaCO2较插管前有明显改善，差异有统计学意义（P〈0．05）。结论在机械通气基础上联合BAL是治疗重症哮喘的有效措施。

Mechanical Ventilation plus Bronchoalveolar Lavage in Management of Severe Asthma

Objective To discuss the roles of mechanical ventilation associated with bronchoalveolar lavage when necessary in treating severe asthma.Methods Eighteen patients no obvious remission with severe asthma respiratory failure after routine treatment were created man-made airway to enforce mechanical ventilation,and performed bronchoalveolar lavage by fibrobronchoscope with saline to clear respiratory tract sputum in the patients with high airway pressure after 24 hours.Results After venting 24h,13 patients' air way resistance began falling off,and 5 patients' PIP was always above 55cmH2O.After treating BAL 2h,24h,PaO2 began to be high gradually,and PaCO2,PIP began to be lower.They had significant differences(P<0.05).Twelve patients off-lined successfully,blood analysis results became normal.The levels of pH,PaO2 and PaCO2 were all significantly improved as compared with before intubation,and the difference was significant(P<0.05).Conclusions Mechanical ventilation associated with bronchoalveolar lavage is effective measure to treat severe asthma.