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目的探讨无创正压通气(NPPV)联合支气管镜治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的临床疗效及安全性。方法选取2012年4月至2014年10月间江苏省东海县人民医院收治的COPD伴呼吸衰竭患者82例进行研究,通过奇偶数分组法将患者分为对照组和观察组各41例。其中对照组给予常规内科联合NPPV治疗,观察组在对照组治疗方法的基础上加用支气管镜灌洗治疗。观察两组患者经治疗后血气指标变化及不良反应发生情况,评价两组治疗方式的临床疗效和安全性。结果观察组治疗后显效率和总有效率为41.46%、90.24%,均高于对照组的19.51%和70.73%,差异有统计学意义(P<0.05)。两组治疗后p H、Pa O2、Sa O2明显升高,Pa CO2明显下降,比较差异有统计学意义(P<0.05);且观察组治疗后p H、Pa O2、Sa O2和Pa CO2指标改善明显优于对照组,差异有统计学意义(P<0.05)。两组患者经治疗后的胃肠胀气、面部红肿、排痰障碍及不耐受等不良反应发生率比较差异无统计学意义(P>0.05),经撤机处理和对症治疗,不良反应均得到有效缓解。结论 NPPV联合支气管镜对COPD伴呼吸衰竭患者临床疗效显著,对血气指标改善明显,安全性好,值得进一步临床推广。
Objective To investigate the clinical efficacy and safety of noninvasive positive pressure ventilation (NPPV) combined with bronchoscopy in the treatment of chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods Eighty-two COPD patients with respiratory failure who were admitted to Donghai County People’s Hospital of Jiangsu Province from April 2012 to October 2014 were selected and divided into control group and observation group by 41 cases in each group. The control group received routine medical treatment combined with NPPV, and the observation group received bronchoscopic lavage treatment on the basis of the control group. The change of blood gas index and the occurrence of adverse reactions in both groups were observed after treatment, and the clinical curative effect and safety of the two groups were evaluated. Results The effective rate and total effective rate of the observation group after treatment were 41.46% and 90.24%, which were all higher than those of the control group (19.51% and 70.73%, P <0.05). After treatment, the levels of p H, Pa O2 and Sa O2 were significantly increased and Pa CO2 was significantly decreased in the two groups (P <0.05). The levels of p H, Pa O2, Sa O2 and Pa CO2 in the observation group after treatment Improve significantly better than the control group, the difference was statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions such as flatulence, facial swelling, expectoration discomfort and intolerance after treatment in both groups (P> 0.05). Adverse reactions were obtained after weaning treatment and symptomatic treatment Ease effectively. Conclusion NPPV combined with bronchoscopy in patients with COPD with respiratory failure significant clinical effect, significant improvement of blood gas indicators, safety, and worth further clinical promotion.