支气管肺泡灌洗联合无创正压通气治疗 COPD合并呼吸衰竭的临床研究
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摘要
目的探讨支气管肺泡灌洗联合无创正压通气治疗COPD合并呼吸衰竭的临床效果。方法回顾性分析2017年10月～2018年9月治疗的116例COPD伴Ⅱ型呼吸衰竭患者临床资料,依据治疗方法的不同将其分为两组,将行无创正压通气治疗的58例患者设为对照组,将行支气管肺泡灌洗联合无创正压通气治疗的58例患者设为观察组。观察两组临床治疗效果、治疗前后动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平。结果两组临床疗效比较差异有统计学意义(P<0.05),观察组总有效率较高。治疗前两组PaO_2、PaCO_2、TNF-α、IL-8水平比较差异无统计学意义(P>0.05);治疗后两组PaCO_2、PaCO_2、TNF-α、IL-8水平均改善(P<0.05或0.01),观察组改善程度高于对照组(P<0.01)。结论支气管肺泡灌洗联合无创正压通气治疗COPD合并呼吸衰竭可有效缓解患者临床症状,改善血气分析指标,下调炎症因子水平。
Objective To investigate the clinical effects of bronchoalveolar lavage combined with non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease(COPD) with respiratory failure.Methods The clinical data of 116 COPD patients with type Ⅱ respiratory failure treated in the hospital from October 2017 to September 2018 were retrospectively analyzed,and they were divided into two groups according to treatment methods.58 patients with non-invasive positive pressure ventilation were selected as control group,and 58 patients with bronchoalveolar lavage combined with non-invasive positive pressure ventilation as observation group.And then,the curative effects as well as the levels of arterial oxygen partial pressure(PaO_2),arterial carbon dioxide partial pressure(PaCO_2),tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8) were observed.Results The difference of clinical curative effects of the two groups was statistically significant(P<0.05),and the total effective rate of the observation group was higher.Before treatment,the difference of the levels of PaO_2,PaCO_2,TNF-α and IL-8 in the two groups was not statistically significant(P>0.05),while they all improved in the two groups after treatment(P<0.05 or 0.01),and those of the observation group improved more significantly than those of the control group(P<0.01).Conclusion Bronchoalveolar lavage combined with non-invasive positive pressure ventilation in the treatment of COPD with respiratory failure can effectively alleviate clinical symptoms,improve blood gas analysis indexes,and down-regulate the levels of inflammatory factors.
Objective To investigate the clinical effects of bronchoalveolar lavage combined with non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease(COPD) with respiratory failure.Methods The clinical data of 116 COPD patients with type Ⅱ respiratory failure treated in the hospital from October 2017 to September 2018 were retrospectively analyzed,and they were divided into two groups according to treatment methods.58 patients with non-invasive positive pressure ventilation were selected as control group,and 58 patients with bronchoalveolar lavage combined with non-invasive positive pressure ventilation as observation group.And then,the curative effects as well as the levels of arterial oxygen partial pressure(PaO_2),arterial carbon dioxide partial pressure(PaCO_2),tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8) were observed.Results The difference of clinical curative effects of the two groups was statistically significant(P<0.05),and the total effective rate of the observation group was higher.Before treatment,the difference of the levels of PaO_2,PaCO_2,TNF-α and IL-8 in the two groups was not statistically significant(P>0.05),while they all improved in the two groups after treatment(P<0.05 or 0.01),and those of the observation group improved more significantly than those of the control group(P<0.01).Conclusion Bronchoalveolar lavage combined with non-invasive positive pressure ventilation in the treatment of COPD with respiratory failure can effectively alleviate clinical symptoms,improve blood gas analysis indexes,and down-regulate the levels of inflammatory factors.
引文
[1] 姜俊广,王海波,陈树伟.无创正压通气联合纤维支气管镜肺灌洗治疗老年慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者临床观察[J].医学综述,2016,22(1):167-170.
[2] 潘虹池,冉梅,张雪漫,等.纤维支气管镜肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的临床疗效及安全性研究[J].实用心脑肺血管病杂志,2015,23(4):13-16.
[3] 沈妍,李欣,秦晓娟.纤维支气管镜肺灌洗对AECOPD合并Ⅱ型呼吸衰竭患者肺功能及炎性因子的影响[J].疑难病杂志,2018,17(7):679-683.
[4] 刘海春,王海波,王振青,等.BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭临床观察[J].河北医学,2015,21(1):24-27.
[5] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[6] 汤超,华文良.AECOPD合并Ⅱ型呼吸衰竭早期应用无创正压通气的临床意义[J].现代中西医结合杂志,2016,25(36):4075-4077.
[7] 魏娉,刘春云.无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效观察[J].中国药物与临床,2015,15(12):1786-1787.
[8] 张秀敏,武海燕,孙晓娟.ICU无创呼吸机对COPD合并Ⅱ型呼吸衰竭的疗效观察[J].海南医学院学报,2016,22(14):1499-1501.
[9] 林卫涵,吴卫锋.纤维支气管镜肺灌洗联合无创正压通气在慢性阻塞性肺疾病合并呼吸衰竭中的应用[J].西部医学,2015,27(1):72-74.
[10] 王发辉,林石宁,徐建光,等.支气管镜肺泡灌洗联合无创正压通气治疗老年慢性阻塞性肺疾病并呼吸衰竭的临床效果[J].实用心脑肺血管病杂志,2017,25(6):93-95.
[11] 吴金如,曾宪升.支气管肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究[J].实用临床医药杂志,2017,21(12):25-28.
[12] 陈家贤.NPPV联合支气管镜灌洗治疗COPD伴呼吸衰竭的临床疗效与安全性[J].热带医学杂志,2016,16(9):1145-1148.
[13] 何世伟.无创正压通气治疗对合并Ⅱ型呼吸衰竭的慢性阻塞性肺疾病患者血气指标、疗效及预后的影响[J].实用临床医药杂志,2016,20(15):83-84.
[14] 古远云,钟洪卫,陈辉,等.参蛤益肺胶囊对COPD稳定期老年患者LTB4、IL-8、TNF-α影响的研究[J].世界中医药,2016,11(9):1697-1699.
[15] 刘剑臻,杜秀芳.COPD急性加重期患者血清CRP和PCT含量与全身炎症反应程度的相关性分析[J].海南医学院学报,2017,23(5):620-622.
[2] 潘虹池,冉梅,张雪漫,等.纤维支气管镜肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的临床疗效及安全性研究[J].实用心脑肺血管病杂志,2015,23(4):13-16.
[3] 沈妍,李欣,秦晓娟.纤维支气管镜肺灌洗对AECOPD合并Ⅱ型呼吸衰竭患者肺功能及炎性因子的影响[J].疑难病杂志,2018,17(7):679-683.
[4] 刘海春,王海波,王振青,等.BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭临床观察[J].河北医学,2015,21(1):24-27.
[5] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[6] 汤超,华文良.AECOPD合并Ⅱ型呼吸衰竭早期应用无创正压通气的临床意义[J].现代中西医结合杂志,2016,25(36):4075-4077.
[7] 魏娉,刘春云.无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效观察[J].中国药物与临床,2015,15(12):1786-1787.
[8] 张秀敏,武海燕,孙晓娟.ICU无创呼吸机对COPD合并Ⅱ型呼吸衰竭的疗效观察[J].海南医学院学报,2016,22(14):1499-1501.
[9] 林卫涵,吴卫锋.纤维支气管镜肺灌洗联合无创正压通气在慢性阻塞性肺疾病合并呼吸衰竭中的应用[J].西部医学,2015,27(1):72-74.
[10] 王发辉,林石宁,徐建光,等.支气管镜肺泡灌洗联合无创正压通气治疗老年慢性阻塞性肺疾病并呼吸衰竭的临床效果[J].实用心脑肺血管病杂志,2017,25(6):93-95.
[11] 吴金如,曾宪升.支气管肺泡灌洗联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床研究[J].实用临床医药杂志,2017,21(12):25-28.
[12] 陈家贤.NPPV联合支气管镜灌洗治疗COPD伴呼吸衰竭的临床疗效与安全性[J].热带医学杂志,2016,16(9):1145-1148.
[13] 何世伟.无创正压通气治疗对合并Ⅱ型呼吸衰竭的慢性阻塞性肺疾病患者血气指标、疗效及预后的影响[J].实用临床医药杂志,2016,20(15):83-84.
[14] 古远云,钟洪卫,陈辉,等.参蛤益肺胶囊对COPD稳定期老年患者LTB4、IL-8、TNF-α影响的研究[J].世界中医药,2016,11(9):1697-1699.
[15] 刘剑臻,杜秀芳.COPD急性加重期患者血清CRP和PCT含量与全身炎症反应程度的相关性分析[J].海南医学院学报,2017,23(5):620-622.