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目的:探讨定时支气管肺泡灌洗(BAL)和脱机前自主呼吸试验,在慢性阻塞性肺疾病(COPD)机械通气患者中的作用。方法:回顾性总结COPD急性发作并呼吸衰竭,接受有创机械通气(时间>48h)患者的诊疗情况。观察组每2d行BAL,依自主呼吸试验脱机拔管。对照组不定时(≥4d)行BAL,依临床经验和SIMV模式脱机拔管。结果:观察组有效率(88.4%)比对照组(69.2%)明显提高(P<0.05)。观察组住院时间/机械通气时间(11.28±3.19d/6.56±2.23d),明显低于对照组(13.44±3.42d/8.79±2.59d)(P<0.05)。观察组和对照组比较,48h再插管率无显著减低(P>0.05)。结论:COPD并发呼吸衰竭,定期BAL和脱机拔管前自主呼吸试验,是一种安全有效的临床综合诊疗措施。
Objective: To investigate the role of bronchial alveolar lavage (BAL) and spontaneous breathing before off-line in chronic obstructive pulmonary disease (COPD) patients with mechanical ventilation. Methods: A retrospective summary of acute exacerbation of COPD and respiratory failure, receiving invasive mechanical ventilation (time> 48h) in patients with diagnosis and treatment. Observation group every 2d BAL, according to spontaneous breath test off the tube. In the control group, BAL was randomized (≥4 days), and extubated according to clinical experience and SIMV mode. Results: The effective rate (88.4%) in the observation group was significantly higher than that in the control group (69.2%) (P <0.05). The duration of hospital stay / mechanical ventilation (11.28 ± 3.19d / 6.56 ± 2.23d) in the observation group was significantly lower than that in the control group (13.44 ± 3.42d / 8.79 ± 2.59d) (P <0.05). Compared with the control group, the rate of reintubation at 48h was not significantly reduced in observation group and control group (P> 0.05). Conclusion: COPD complicated with respiratory failure, regular BAL and spontaneous breath test before extubation is a safe and effective clinical diagnosis and treatment.