| 胡东东,李石岩,沈新秀,等.支气管肺泡灌洗联合无创正压通气治疗老年重症肺炎并Ⅱ型呼吸衰竭 35例[J].安徽医药,2021,25(11):2261-2265. |
| 支气管肺泡灌洗联合无创正压通气治疗老年重症肺炎并Ⅱ型呼吸衰竭 35例 |
| Bronchoalveolar lavage combined with NIPPV in the treatment of 35 elderly patients with severe pneumonia and type Ⅱ respiratory failure |
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| DOI：10.3969/j.issn.1009-6469.2021.11.032 |
| 中文关键词: 肺炎 呼吸功能不全 支气管肺泡灌洗 无创正压通气 血气分析指标 老年人 |
| 英文关键词: Pneumonia Respiratory insufficiency Bronchoalveolar lavage Noninvasive positive pressure ventilation Severe pneumonia Aged |
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| 中文摘要: |
| 目的探究支气管肺泡灌洗联合无创正压通气( NIPPV)对老年重症肺炎并 Ⅱ型呼吸衰竭的疗效。方法采用随机对照试验设计，选取 2017年 10月至 2019年 10月南京医科大学第四附属医院收治的老年重症肺炎合并 Ⅱ型呼吸衰竭病人 67例，按照随机数字表法分为观察组 35例与对照组 32例，均给予常规治疗，对照组同时给予 NIPPV，观察组在对照组基础上给予支气管肺泡灌洗治疗，对比两组血气分析指标、氧合指数( PaO2/FiO2)、健康状况评分、血清炎性因子、有创机械通气率、住 ICU时间及病死率。结果治疗后，两组二氧化碳分压( PaCO2)均降低，观察组低于对照组［( 48.21±5.18)mmHg比( 53.02±7.94) mmHg，P<0.05］，血氧饱和度( SaO2)、血氧分压( PaO2)、 PaO2/FiO2均较治疗前升高，观察组 SaO2高于对照组［( 91.73±8.31)%比(87.06±7.20)%，P<0.05］，PaO2、PaO2/FiO2均显著高于对照组( P<0.001)；治疗后，两组 APACHEⅡ评分均下降，观察组低于对照组［(7.68±1.83)分比( 9.12±2.45)分， P<0.05］两组治疗前后比较差异有统计学意义( P<0.001)；治疗后两组血清 CRP、IL-6均明显下降，且观察组低于对照组，组内及组间比较，均差异有统计学意义( P<0.001)；观察组有创机械通气率低于对照组，差异有统计学意义( 5.71%比 28.13%，P<0.05)住 ICU时间明显短于对照组［(8.49±3.06)d比( 13.87±5.13)d，P<0.001］。观察组与对照组病死率比较，差异无统计学意义( 11.43%，比 18.75%，P>0.05)。结论支气管肺泡灌洗联合 NIPPV治疗老年重症肺炎并 Ⅱ型呼吸衰竭效果确切，可有效纠正呼吸衰竭症状，减轻机体炎症反应，改善呼吸功能，降低转有创机械通气率，并可在一定程度上缩短住 ICU时间，降低病死率。 |
| 英文摘要: |
| Objective To explore the effect of bronchoalveolar lavage combined with noninvasive positive pressure ventilation (NIPPV) on elderly patients with severe pneumonia and type II respiratory failure.Methods A randomized controlled trial design was usedto select 67 elderly patients with severe pneumonia and type II respiratory failure who were admitted to The Fourth Affiliated Hospitalof Nanjing Medical University from October 2017 to October 2019, and according to the method of random number table, they were assigned into observation group and control group, all patients were given routine treatment, the control group was given NIPPV at thesame time, and the observation group was given bronchoalveolar lavage on the basis of the control group. The blood gas analysis index,Oxygenation index (PaO2/FiO2), health status score, serum inflammatory factors, invasive mechanical ventilation, ICU stay time and mortality were compared between the two groups.Results After the treatment, the PaO2 of the two groups decreased, PaO2 of the observation group was lower than that of the control group [(48.21±5.18) mmHg vs. (53.02±7.94) mmHg, P<0.05], the SaO2, PaO2 and PaO2 /FiO2increased,theSaO2inobservationgroupwashigherthanthatofthecontrolgroup [(91.73±8.31)% vs. (87.06±7.20)%, P<0.05], the PaO2 and PaO2 /FiO2 were significantly higher than that of the control group (P<0.001); after treatment, the APACHE Ⅱ scores of the two groups decreased, PaO2 of of the observation group was lower than that of the control group [(7.68±1.83) vs. (9.12±2.45), P<0.05], and there was a statistical difference between the two groups (P<0.05); after treatment, the serum CRP and IL-6 of the two groups decreased significantly, serum CRP and IL-6 of the observation group were lower than those of the control group, and the difference between the two groups was statistically significant (P<0.001); the invasive mechanical ventilation in the observation group was signifi cantly lower than that in the control group, and the difference was statistically significant (5.71% vs. 28.13%, P<0.05), and ICU stay time was significantly higher than that of the control group [(8.49±3.06) d vs. (13.87±5.13) d, P<0.001]; the mortality of the observationgroup was 11.43%, which was lower than that of the control group (18.75%), and there was no significant difference (P>0.05).Conclu? sion Bronchoalveolar lavage combined with NIPPV is effective in the treatment of elderly patients with severe pneumonia and type IIrespiratory failure. It can effectively correct the symptoms of respiratory failure, reduce the inflammatory response of the body, improverespiratory function and reduce invasive mechanical ventilation, shorten the ICU stay time to a certain extent, and reduce the mortality. |
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