【摘要】 目的:探讨无创正压通气（NIPPV）联合纤维支气管镜下肺泡灌洗治疗慢性阻塞性肺疾病（COPD）合并严重呼吸衰竭的疗效。方法:选取2017年4月至2018年6月广东省江门市人民医院呼吸科收治的60例COPD合并严重呼吸衰竭患者,按随机数字表法分为观察组和对照组,每组30例。对照组给予常规药物及NIPPV治疗,观察组在对照组治疗基础上进行纤维支气管镜下肺泡灌洗。比较两组临床疗效、气管插管率、机械通气时间、住院时间及治疗前、后的血气分析指标。结果:观察组治疗总有效率为93.33%,显著高于对照组的73.33%（P<0.05）。与对照组比较,观察组气管插管率明显降低,机械通气时间及住院时间明显缩短,差异均有统计学意义（均P<0.05）。治疗后,观察组pH值、动脉血氧分压（PaO₂）及经皮动脉血氧饱和度（SaO₂）明显高于治疗前及对照组,动脉血二氧化碳分压（PaCO₂）低于治疗前及对照组,差异均有统计学意义（均P<0.05）。结论:NIPPV联合纤维支气管镜下肺泡灌洗治疗COPD合并严重呼吸衰竭的疗效显著,可有效改善患者肺功能,缩短住院时间。更多还原

【Abstract】 Objective:To investigate the effect of non-invasive positive pressure ventilation（NIPPV）combined with alveolar lavage under fiberoptic bronchoscopy in the treatment of chronic obstructive pulmonary disease（COPD）complicated with severe respiratory failure.Methods:A total of 60 COPD combined with severe respiratory failure patients treated in our hospital from April 2017 to June 2018 were selected,and randomly divided into a control group and an observation group,with 30 cases in each group.The patients in the control group were treated with conventional medication and noninvasive positive pressure ventilation,while those in the observation group were treated as the control group with addition of alveolar lavage under fiberoptic bronchoscopy.The clinical efficacy,tracheal intubation rate,blood-gas analysis indexes,adverse reactions,hospital days and mechanical ventilation time were compared between the two groups.Results:The total effective rate of the observation group was 93.33%,which was significantly higher than that of the control group（73.33%）（P<0.05）.Compared with the control group,the tracheal intubation rate in the observation group was significantly decreased,and the mechanical ventilation time and hospital days were shortened（P<0.05）.The pH value,arterial partial pressure of oxygen（PaO₂）and percutaneous arterial oxygen saturation（SaO₂）in the observation group were higher than those in the control group,and the arterial partial pressure of carbon dioxide（PaCO₂）was significantly lower（P<0.05）.Conclusion:NIPPV combined with bronchoalveolar lavage under fiberoptic bronchoscopy was effective in the treatment of COPD complicated with severe respiratory failure.It could improve pulmonary function and reduce hospital days.更多还原