纤支镜联合无创通气在慢性阻塞性肺疾病机械通气撤离中的作用

目的 探讨纤支镜支气管灌洗联合无创通气在COPD机械通气患者中的价值.方法 对2007年1月～2011年1月因呼吸衰竭需机械通气的ICU的57例AECOPD患者,随机分组,采用不同的治疗方法观察分析.对照组常规机械通气,解痉、平喘,加强抗感染等处理,达到撤机指证后进行自主呼吸试验(SBT),失败者拔管后辅以无创通气；治疗组在常规治疗的同时予纤支镜吸痰、支气管灌洗,SBT成功和失败患者拔管后均辅以无创通气,观察两组有创通气时间、SBT通过率、再插管及30天的死亡情况.结果 治疗组明显提高SBT成功率和减少再插管率,但在有创通气时间和30天死亡率两者无显著差异.结论 纤支镜辅以无创通气能提高COPD机械通气患者SBT的成功率,降低拔管后的再插管率.

Effects of bronchofibroscope combined with non-invasive ventilation in weaning from mechanical ventilation patients of chronic obstructive pulmonary disease

Objective To explore the role of bronchofibroscope combined with non-invasive ventilation in weaning from mechanical ventilation patients of chronic obstructive pulmonary disease.Methods From Jan 2007 to Jan 2011,57 patients of AECOPD treated with mechanical ventilation were divided into control group and treated group randomly.27 patients in the control group were given commonly treated procedure,including mechanical ventilation,spasmolysis,antiasthma and anti-infection.Patients of the spontaneously breathing testing failure were given non-invasive ventilation.Another 30 patients were treated with aspiration of sputum and bronchial lavage under the euthyphoria of bronchofibroscope.After successful extubation,non-invasive ventilation was given continually.The invasive ventilation time,success ratio of spontaneously breathing testing,ratio of re-intubation and the mortality of day 30 between the two groups were compared,respectively.Results The success ratio of spontaneously breathing testing was increased and the ratio of re-intubation decreased significantly in the treated group compared with those of the control group.However,there was no significant difference on the invasive ventilation time and the mortality of day 30 between the two groups.Conclusions Bronchofibroscope combined with non-invasive ventilation could enhance the success ratio of spontaneously breathing testing and decrease the ratio of re-intubation for the mechanical ventilation patients of chronic obstructive pulmonary disease.