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目的探讨机械通气联合纤维支气管镜支气管肺段冲洗治疗重症哮喘的临床应用价值。方法22例重症哮喘患者,经气管插管呼吸机辅助呼吸,并进行纤维支气管镜肺段冲洗。机械通气的开始阶段,吸入氧浓度(FiO2)一般为60%～80%,待患者PaO2>60mmHg,将FiO2降至40%～50%,2h后复查血气分析;若PaO2仍<60mmHg,加用呼气末正压(PEEP)(从3cmH2O开始),一旦病情好转,可采用同步间歇指令通气(SIMV)+压力支持通气(PSV)过渡,直至拔管。结果22例中12例上机后气道压力不能控制在满意水平,经纤维支气管镜进行肺泡冲洗,吸出多量黏稠痰液和痰栓后气道压力控制在满意水平;另10例也进行不同程度的支气管冲洗和吸引。5例肺不张全部复张,18例X线胸片肺部感染阴影大部分消散,15例血白细胞和中性粒细胞转为正常范围,10例患者3d内体温下降至正常,7例患者3d内意识转清。缺氧及CO2潴留明显纠正。最快于插管后48h撤机,最迟于10d撤机,平均5d撤机。撤机前病人临床症状缓解,哮鸣音消除。结论机械通气与纤维支气管镜肺段冲洗联用是救治重症哮喘的一种有效方法。
Objective To investigate the clinical value of mechanical ventilation combined with bronchofibroscope bronchoalveolar lavage in the treatment of severe asthma. Methods Twenty-two patients with severe asthma were ventilated with endotracheal intubation ventilator and were treated with bronchoscopy. At the beginning of mechanical ventilation, the inhaled oxygen concentration (FiO2) is generally 60% ~ 80%, when the patient PaO2> 60mmHg, the FiO2 reduced to 40% ~ 50%, 2h after the review blood gas analysis; PaO2 is still <60mmHg, plus Positive end-expiratory pressure (PEEP), beginning at 3cmH2O, can be followed by Sims intermittent mandatory ventilation (PSV) transition until extubation, once the condition improves. Results In the 22 cases, 12 cases of post-operative airway pressure could not be controlled at a satisfactory level. Bronchoscope was used for alveolar flushing, airway pressure was controlled at a satisfactory level after suctioning a large amount of viscous sputum and sputum. The other 10 cases were also treated with different degrees Bronchial irrigation and attraction. 5 cases of atelectasis all the rest, 18 cases of chest X-ray film most of the shadow of lung infection disappeared, 15 cases of leukocytes and neutrophils into the normal range, 10 patients 3d body temperature dropped to normal, 7 patients 3d awareness to clear. Hypoxia and CO2 retention were significantly corrected. 48h after intubation as soon as possible after weaning, the weaning at 10d, the average 5d weaning. Weakening before the patient’s clinical symptoms, wheeze elimination. Conclusion Mechanical ventilation combined with bronchofibroscopy was an effective method to treat severe asthma.