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目的:观察纤维支气管镜支气管-肺泡灌洗术辅助治疗急性期ARDS的临床治疗效果。方法:80例ICU住院并发生ARDS后经有创机械通气危重症患者,其中男46例,女34例,年龄36-87岁;随机分为支气管肺泡灌洗辅助治疗组(A组:ARDS发生后第三天行支气管肺泡灌洗一次)和一般吸痰治疗组(B组)。观察2组患者治疗前后体温、呼吸频率、PaO2/FiO2等情况。比较2组肺部感染控制时间窗、有创通气时间、ICU住院时间及住ICU期间死亡例数。结果:A组在灌洗后体温、呼吸频率及PaO2/FiO2较灌洗前有所改善(P<0.05)。在1周的观察期内,A组的各项指标改善情况优于B组,差异有统计学意义(P<0.05)。感染控制窗出现时间及有创机械通气时间明显缩短(P<0.05),2组间ICU住院时间及死亡率无统计学差异(P>0.05)。结论:对ARDS早期病人给予支气管-肺泡灌洗,可以有效提高病人PaO2,改善氧合,准确提供肺部感染的病原学诊断并有效控制感染,为针对原发病的综合治疗创造条件。
Objective: To observe the clinical effect of bronchial bronchoalveolar lavage assisted with ARDS in acute stage. Methods: Eighty ICU patients were admitted to our hospital and underwent ARDS. 46 male and 34 female patients aged 36-87 were randomly divided into bronchoalveolar lavage adjuvant (A group), ARDS After the third day of bronchoalveolar lavage once) and general suction treatment group (B group). The body temperature, respiratory rate, PaO2 / FiO2 and other conditions were observed before and after treatment in two groups. The time window of pneumoconiosis control, invasive ventilation, ICU stay and ICU deaths were compared between the two groups. Results: Body temperature, respiratory rate and PaO2 / FiO2 in group A were significantly improved after lavage (P <0.05). During the 1-week observation period, the improvement of each index in group A was better than that in group B, the difference was statistically significant (P <0.05). Infection control window appearance time and invasive mechanical ventilation time was significantly shorter (P <0.05), ICU length of hospital stay and mortality between the two groups was not statistically significant (P> 0.05). Conclusion: Bronchial-alveolar lavage of patients with early ARDS can effectively improve patient PaO2, improve oxygenation, accurately provide etiological diagnosis of pulmonary infection and effectively control infection, and create conditions for the comprehensive treatment of primary disease.