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目的 :评估早期大容量支气管 -肺灌洗 (BAL)治疗慢性阻塞性肺疾病 (COPD)伴严重呼吸衰竭对呼吸力学的影响和治疗效果。方法 :选择接受气管插管下机械通气的COPD病例 1 4例 ,早期行大容量BAL治疗 ,分别观察比较BAL前与BAL后 1h、1 2h肺动态顺应性 (Cdyn)、肺粘性阻力 (Rrs)、气道峰压 (PIP)、平台压(Pplateau)、平均气道压 (Mpaw)和内源性呼气末正压 (PEEPi)。并回顾性选择同样病情未行BAL的COPD病例 1 4例为对照组 ,动态记录比较两组的肺感染控制时间 ,机械通气时间和住重症病房 (ICU )天数。结果 :BAL组治疗后 1、1 2h与BAL前呼吸力学参数分别为 :Cdyn(0 .48± 0 .86)、(0 .54± 0 .1 3)和 (0 .2 8± 0 .64)L/kPa ,P均 <0 .0 1 ;Rrs(1 .1 0± 0 .2 6)、(1 .0 3± 0 .2 3)和 (1 .61± 0 .2 3)kPa/s/L ,P均 <0 .0 1 ;PIP(2 .2 4± 0 .48)、(1 .62± 0 .44)和 (2 .74± 0 .46)kPa ,1hP <0 .0 5、1 2hP <0 .0 1 ;Pplateau(1 .2 4± 0 .2 8)、(1 .2 7± 0 .40 )和 <1 .2 3± 0 .37)kPa ,P均 >0 .0 5 ;Mpaw(9.95± 0 .1 9)、(0 .92± 0 .33)和 (1 .2 7± 0 .2 8)kPa,P均 <0 .0 1 ;PEEPi(0 .55±0 .1 2 )、(0 .43± 0 .0 8)和 (0 .59± 0 .2 4 )kPa,1hP >0 .0 5、1 2hP <0 .0 1。BAL组与对照组比较感染控制时?
OBJECTIVE: To evaluate the effects of early large-volume bronchial-pulmonary lavage (BAL) on respiratory mechanics and treatment of chronic obstructive pulmonary disease (COPD) with severe respiratory failure. Methods: Twenty-four COPD patients undergoing mechanical ventilation under endotracheal intubation were enrolled in this study. Early high-volume BAL treatment was performed. The changes of dynamic lung compliance (Cdyn), pulmonary visco-resistance (Rrs) PIP, Pplateau, Mpaw, and PEEPi. A retrospective study of 14 COPD patients with the same disease who did not undergo BAL was retrospectively reviewed. The duration of lung infection control, mechanical ventilation and intensive care unit (ICU) days were dynamically recorded. Results: The mechanical parameters of BAL in BAL group after 1, 2h and BAL were: Cdyn (0.48 ± 0.86), (0.54 ± 0.13) and (0.28 ± 0.64 ) L / kPa, P <0.01; Rrs (1.1 ± 0.2.6), (1.03 ± 0.23) and (1.61 ± 0.23) kPa / s / L, P <0. 01; PIP (2.24 ± 0.48), (1.62 ± 0.44) and (2.74 ± 0.46) kPa, 1hP < 5,1 2hP <0. 01; Pplateau (1.24 ± 0.28), (1.27 ± 0.40) and <1.33 ± 0.37 kPa, P> 0 .0 5; Mpaw (9.95 ± 0.19), (0.92 ± 0.33) and (1.27 ± 0.28) kPa, all P <0.01; PEEPi ± 0 .1 2), (0 .43 ± 0 .0 8) and (0 .59 ± 0 .24) kPa, 1hP> 0 .0 5,1 2hP <0 .0 1. BAL control group compared with infection control?