支气管镜肺泡灌洗联合序贯机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭

目的：探究并分析支气管镜肺泡灌洗联合有创-无创机械通气序贯治疗慢性阻塞性肺疾病（ COPD）合并呼吸衰竭的临床疗效。方法选取自2011年1月至2013年12月本院收治的100例COPD合并呼吸衰竭患者，按随机数表法将患者分为观察组和对照组，每组各50例。对照组患者采取有创机械通气治疗，观察组患者采取支气管镜肺泡灌洗联合有创-无创序贯机械通气治疗，观察并比较两组患者治疗后的疗效。结果观察组患者呼吸衰竭纠正时间、感染控制窗出现时间、总机械通气时间、住院时间均明显短于对照组患者；切换时间窗后两组患者血气分析各项指标较治疗前明显改变，观察组患者切换时间窗后pH、PaO2明显高于对照组，而PaCO2明显低于对照组，两组差异有显著性（P〈0.05）；观察组患者治疗后并发症的总发生率为10%，明显低于对照组（40%），差异有显著性（P〈0.05）。结论支气管镜肺泡灌洗联合序贯机械通气治疗COPD合并呼吸衰竭具有显著的疗效，不仅能有效改善COPD患者的症状、控制感染、缩短住院时间，还能减少呼吸机相关性肺炎等并发症的发生率。

Servation on the Clinical Efficacy of Bronchoalveolar Lavage Combined with Sequential Me-chanical Ventilation in the Treatment of COPD with Respiratory Failure

Objective To explore and analyze the clinical efficacy of bronchoalveolar lavage combined with invasive noninvasive mechanical ventilation sequential therapy in the treatment of chronic obstructive pulmonary disease （ COPD） patients with respiratory failure. Method 100 cases of COPD complicated with respiratory failure patients from January 2011 to Decwmber 2013 in our hospital were selected according to the random number table, which were divided into observation group and control group, each group with 50 cases. The patients in control group were treated with invasive mechanical ventilation, while the observation group patients with the bronchoalveolar lavage therapy combined with sequential invasive-noninvasive mechanical ventilation therapy. Curative effect was observed and compared between the two groups after treatment. Result The infection correcting time, the total duration of me-chanical ventilation, duration of hospitalization of patients with respiratory failure were significantly shorter than those of the control group;each index with blood gas analysis in the two groups after switching windows significantly changed,pH, and PaO2 of the observation group patients after switching time window were significantly higher than those of the control group, and the PaCO2 was significantly lower than that of the control group, and the two groups had significant difference（P〈0. 05）; the overall complication rate of the patients in observation group after treat-ment was 10%, significantly lower than that of the control group （40%）,with statistical significance（P〈0. 05）. Conclusion Bronchoalveolar lavage combined with sequential mechanical ventilation has significant curative effect in the treatment of COPD with respiratory failure, not only can effectively improve the symptoms of the COPD patients, control the infection, shorten the time of hospitalization, but also reduce the incidence of ventilator-associated pneu-monia and other complications rate; therefore it is an effective means of treat