本文選題：慢性阻塞性肺疾病 + 機(jī)械通氣��； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：目的 探討支氣管肺泡灌洗（bronchoalveolar lavage，，BAL）治療對(duì)行有創(chuàng)-無(wú)創(chuàng)序貫機(jī)械通氣的慢性阻塞性肺疾病急性加重（acute exacerbation chronic obstructivepulmonary disease， AECOPD）并嚴(yán)重呼吸衰竭患者的肺部感染窗時(shí)間(pulmonary infection control window，PIC window)、機(jī)械通氣時(shí)間、呼吸機(jī)相關(guān)性肺炎（ventilator-associated pneumonia，VAP）的發(fā)生率、拔管后48小時(shí)再插管率，病原學(xué)檢出率以及預(yù)后的影響。 方法 選擇因支氣管-肺部感染加重導(dǎo)致AECOPD并嚴(yán)重呼吸衰竭行有創(chuàng)機(jī)械通氣的患者61例，隨機(jī)分為兩組，治療組32例，對(duì)照組29例，兩組均以PIC窗為切換點(diǎn)實(shí)施有創(chuàng)-無(wú)創(chuàng)序貫機(jī)械通氣，治療組聯(lián)合應(yīng)用BAL。當(dāng)兩組患者出現(xiàn)PIC窗后均拔除氣管插管，給予無(wú)創(chuàng)正壓通氣，以后逐漸降低呼吸機(jī)支持力度直至撤離無(wú)創(chuàng)通氣改為文丘里面罩吸氧，期間如果病情惡化并達(dá)到重新插管指證，則再次給予氣管插管行有創(chuàng)機(jī)械通氣，以轉(zhuǎn)出呼吸加強(qiáng)治療病房（respiratory intensivecare unit，RICU）或院內(nèi)死亡為觀察終點(diǎn)，主要觀察兩組PIC窗出現(xiàn)的時(shí)間(即有創(chuàng)通氣切換為無(wú)創(chuàng)通氣的時(shí)間)、總的機(jī)械通氣時(shí)間、VAP的發(fā)生率、拔管后48小時(shí)再插管率、病原學(xué)檢出率、院內(nèi)死亡率。 結(jié)果 1.對(duì)照組PIC窗出現(xiàn)的時(shí)間(即有創(chuàng)通氣切換為無(wú)創(chuàng)通氣的時(shí)間)為(6.2±1.8)d，治療組PIC窗出現(xiàn)的時(shí)間(即有創(chuàng)通氣切換為無(wú)創(chuàng)通氣的時(shí)間)為(3.8±1.0)d，和對(duì)照組相比，治療組PIC窗明顯提前，有創(chuàng)機(jī)械通氣時(shí)間顯著減少(P0．01)。 2..對(duì)照組總的機(jī)械通氣時(shí)間為（15.5±5.2）d，治療組總的機(jī)械通氣時(shí)間為（12.6±5.3）d，和對(duì)照組相比，治療組總的機(jī)械通氣時(shí)間顯著減少(P0．05)。 3.對(duì)照組VAP發(fā)生率為20.69%，治療組VAP發(fā)生率為9.38%，和對(duì)照組相比，治療組VAP發(fā)生率明顯降低(P0．05)。 4.對(duì)照組病原學(xué)檢出率41.38%，治療組病原學(xué)檢出率78.13%，治療組病原學(xué)檢出率明顯高于對(duì)照組(P0．01)。 5.對(duì)照組拔管后48小時(shí)重新插管率13.793%，治療組拔管后48小時(shí)重新插管率3.125%，治療組拔管后48小時(shí)重新插管率明顯低于對(duì)照組(PO．05)。 6.對(duì)照組院內(nèi)死亡率13.793%，治療組院內(nèi)死亡率3.125%，治療組死亡率明顯低于對(duì)照組(P0．05)。 7.治療組共行床旁支氣管肺泡灌洗118例次，在灌洗操作中均出現(xiàn)一過(guò)性心律失常、缺氧的表現(xiàn)，其中術(shù)后發(fā)熱6例次，輕微的支氣管痙攣2例次，支氣管粘膜滲血2例次。 結(jié)論 1. BAL聯(lián)合有創(chuàng)-無(wú)創(chuàng)序貫機(jī)械通氣治療因支氣管-肺部感染致AECOPD并呼吸衰竭患者，可以促使PIC窗提前，縮短有創(chuàng)通氣時(shí)間，降低VAP發(fā)生率,提高病原學(xué)檢出率，降低48小時(shí)再插管率，從而改善預(yù)后。 2.行BAL可出現(xiàn)一過(guò)性心律失常、缺氧、支氣管痙攣、支氣管粘膜滲血及術(shù)后發(fā)熱等并發(fā)癥，大多停止操作，給予簡(jiǎn)單處理，甚至不處理也能緩解或恢復(fù)正常，未出現(xiàn)嚴(yán)重并發(fā)癥，BAL是一項(xiàng)相對(duì)安全的治療措施。
[Abstract]:Purpose To investigate the time of pulmonary infection control window infection and mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and severe respiratory failure after bronchoalveolar lavage with bronchoalveolar lavage (BALL) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and severe respiratory failure. The incidence of ventilator-associated pneumonia (VAP), the rate of re-intubation 48 hours after extubation, the detection rate of etiology and the influence of prognosis. Method Sixty-one patients with AECOPD and severe respiratory failure due to bronchopulmonary infection were randomly divided into two groups: treatment group (n = 32) and control group (n = 29). PIC window was used as switching point in both groups. When PIC window appeared in both groups, tracheal intubation was removed, non-invasive positive pressure ventilation was given, and the support intensity of ventilator was gradually reduced until the withdrawal of non-invasive ventilation was replaced by Venturi mask oxygen inhalation, during which time, if the condition deteriorated and the indication of re-intubation was reached, He was again given tracheal intubation for invasive mechanical ventilation, and the end point was to transfer out of the respiratory intensive care unit (intensivecare unitricu) or to hospital death. The time of emergence of PIC window (that is, the time when invasive ventilation was switched to non-invasive ventilation), the incidence of total mechanical ventilation time, the rate of re-intubation 48 hours after extubation, the detection rate of etiology, and the mortality in hospital were observed. Result 1. The time of PIC window in the control group was 6.2 鹵1.8 days, and that of the PIC window in the treatment group was 3.8 鹵1.0 days. Compared with the control group, the PIC window in the treatment group was significantly earlier than that in the control group. The time of invasive mechanical ventilation was decreased significantly (P 0.01). 2.. The total mechanical ventilation time of the control group was 15.5 鹵5.2 days, and the total mechanical ventilation time of the treatment group was 12.6 鹵5.3 days. Compared with the control group, the total mechanical ventilation time of the treatment group was significantly reduced to 0.05%. 3. The incidence of VAP in the control group was 20.69 and the incidence of VAP in the treatment group was 9.38. Compared with the control group, the incidence of VAP in the treatment group was significantly lower than that in the control group (P 0.05). 4. The detection rate of etiology in the control group was 41.38 and that in the treatment group was 78.13. The detection rate of the treatment group was significantly higher than that of the control group (P 0.01). 5. The rate of re-intubation 48 hours after extubation was 13.793 in the control group and 3.125 in the treatment group 48 hours after extubation. The rate of re-intubation 48 hours after extubation in the treatment group was significantly lower than that in the control group. 6. The hospital mortality in the control group was 13.793, and the hospital mortality in the treatment group was 3.125. The mortality in the treatment group was significantly lower than that in the control group (P 0.05). 7. In the treatment group, 118 cases of bronchoalveolar lavage were performed by bedside bronchoalveolar lavage. Transient arrhythmias and anoxia were found in all cases during the lavage operation, including 6 cases of postoperative fever, 2 cases of mild bronchiospasm and 2 cases of osmosis of bronchial mucosa. Conclusion 1. BAL combined with invasive sequential mechanical ventilation in the treatment of patients with AECOPD and respiratory failure caused by bronchopulmonary infection can advance the PIC window, shorten the time of invasive ventilation, reduce the incidence of VAP, and increase the detection rate of etiology. Reduce the rate of 48 hours re-intubation, thereby improving the prognosis. 2. Complications such as transient arrhythmia, anoxia, bronchospasm, blood leakage of bronchial mucosa and postoperative fever can occur after BAL. Most of the complications can be alleviated or returned to normal by simple or even untreated treatment. BAL without severe complications is a relatively safe treatment.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R563.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 姚婉貞,朱紅,沈?qū)?韓翔,梁巖靜,張立強(qiáng),孫永昌,郝振婷,趙鳴武;北京市延慶縣慢性阻塞性肺疾病流行病學(xué)調(diào)查結(jié)果[J];北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2005年02期

2 劉景艷,修清玉;細(xì)胞因子在慢性阻塞性肺疾病發(fā)病中的作用[J];國(guó)外醫(yī)學(xué).呼吸系統(tǒng)分冊(cè);2005年06期

3 鐘定,許輝,陽(yáng)顯慧,覃壽明;支氣管肺泡灌洗和支纖鏡檢術(shù)后感染率的比較[J];廣西醫(yī)科大學(xué)學(xué)報(bào);1997年02期

4 張杰,翁心植;纖維支氣管鏡在機(jī)械通氣患者中的應(yīng)用[J];內(nèi)科急危重癥雜志;1997年03期

5 楊秀芬,閻錫新;氣囊上滯留物與呼吸機(jī)相關(guān)肺炎的相關(guān)性研究[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2005年04期

6 徐小勇;魏淑珍;張峰;張鵬鵬;施毅;;熱濕交換器和加熱濕化器對(duì)呼吸機(jī)相關(guān)性肺炎的預(yù)防價(jià)值[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2011年03期

7 劉瓊,黃紀(jì)堅(jiān),周發(fā)春;纖維支氣管鏡支氣管肺泡灌洗加注抗生素治療呼吸機(jī)相關(guān)性肺炎58例[J];中國(guó)內(nèi)鏡雜志;2005年02期

8 曹志新,王辰;無(wú)創(chuàng)機(jī)械通氣的應(yīng)用范圍及指征[J];中華結(jié)核和呼吸雜志;2002年03期

9 ;支氣管肺泡灌洗液細(xì)胞學(xué)檢測(cè)技術(shù)規(guī)范(草案)[J];中華結(jié)核和呼吸雜志;2002年07期

10 慢性阻塞性肺疾病無(wú)創(chuàng)機(jī)械通氣治療研究協(xié)作組;早期應(yīng)用無(wú)創(chuàng)正壓通氣治療慢性阻塞性肺疾病急性加重期患者的多中心隨機(jī)對(duì)照研究[J];中華結(jié)核和呼吸雜志;2005年10期

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