标题：NIPPV联合FB检查治疗AECOPD合并Ⅱ型呼吸衰竭患者疗效观察

      作者：林芳崇，林明强，王日兴，黄大海，吕有凯
    (海南省农垦总医院急诊科，海南 海口 570311)

      卷次： 2016年27卷15期

      【摘要】 目的 观察无创正压通气(NIPPV)联合纤维支气管镜(FB)检查治疗急性加重期慢性阻塞性肺疾病患
者(AECOPD)合并Ⅱ型呼吸衰竭的效果。方法 以2014年3月至2015年3月在我院治疗的80例AECOPD合并Ⅱ
型呼吸衰竭患者为观察对象。根据随机数表法将其分为对照组和观察组，每组各40例。对照组给予NIPPV治疗，观
察组在NIPPV治疗1 h后给予床旁FB检查及灌洗治疗。比较两组患者的治疗效果、治疗前后的血气指标、肺功能的
变化，以及治疗前后APACHEⅡ和意识得分的差异。结果 观察组患者的治疗总有效率为95.0% (38/40)，明显高于
对照组的77.5% (31/40)，差异具有统计学意义(P<0.05)；两组患者治疗前的肺功能和血气指标比较差异均无统计学意
义(P>0.05)，治疗后，两组患者的FVC、FEV1、FEV1/FVC、PaO2和pH均较治疗前升高，PaCO2均较治疗前降低，且观察
组降低更明显，差异均具有统计学意义(P<0.05)；治疗前两组患者的APACHEⅡ和意识评分比较差异均无统计学意义
(P>0.05)，治疗后，两组患者的上述指标均降低，且观察组降低更明显，差异均具有统计学意义(P<0.05)；观察组患者腹
胀、面部受压、口干、头晕和腹痛的发生率为 52.5% (21/40)，对照组为 47.5% (19/40)，差异无统计学意义(P>0.05)。
结论 NIPPV联合FB检查治疗对AECOPD合并Ⅱ型呼吸衰竭有较好的治疗效果，且不会增加相关并发症的发生。

      【关键词】 无创正压通气；纤维支气管镜；急性加重期慢性阻塞性肺疾病；呼吸衰竭；疗效

      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2016）15—2447—03


Effect of noninvasive positive pressure ventilation combined with fiberoptic bronchoscopy in the treatment of
patients with acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory
failure.
LIN Fang-chong, LIN Ming-qiang, WANG Ri-xing, HUANG Da-hai, LV You-kai. Emergency Department,
Hainan Provincial Nongken General Hospital, Haikou 571100, Hainan, CHINA

【Abstract】 Objective To observe the therapeutic effect of noninvasive positive pressure ventilation (NIP-
PV) combined with fiberoptic bronchoscopy (FB) in the treatment of acute exacerbation of chronic obstructive pul-
monary disease (AECOPD) complicated with type Ⅱ respiratory failure. Methods Eighty patients of AECOPD
with type Ⅱ respiratory failure treated in our hospital from March 2014 to March 2015 were selected and randomly di-
vided into control group and observation group according to the way of treatment, with 40 cases in each group. The con-
trol group received NIPPV, and the observation group was given fiberoptic FB bedside examination and lavage 1 h after
NIPPV. To observe the therapeutic effect of two groups, the blood gas index and pulmonary function before and after
treatment were compared between the two groups. APACHEⅡ and consciousness score were compared before and after
treatment. Results The total effective rate of observation group was 95.0% (38/40), which was significantly higher
than that of the control group [77.5% (31/40)], and the difference was statistically different (P<0.05). Lung function and
blood gas index had no significant difference before treatment (P>0.05). After treatment, the levels of forced vital capacity
(FVC), forced expiratory volume (FEV), forced expiratory volume in 1 second (FEV1), FEV1/FVC, PaO2 and pH in the
two groups all increased, and the level of PaCO2 all decreased, with the observation group changed more significantly
(P<0.05). Before treatment, APACHE Ⅱ and consciousness score of the two groups had no significant difference. After
treatment, the above indexes of the two groups all decreased, and the observation group decreased more significantly (P<
0.05). The incidence rate of abdominal distension, facial pressure, dry mouth, dizziness and abdominal pain in observa-
tion group was 52.5% (21/40), and that of the control group was 47.5% (19/40), with no statistically significant differ-
ence between the two groups (P>0.05). Conclusion NIPPV combined with FB examination has a better therapeutic ef-
fect on the treatment of AECOPD with typeⅡ respiratory failure, and not increase the occurrence of complications.

      【Key words】 Noninvasive positive pressure ventilation (NIPPV); Fiberoptic bronchoscopy (FB); Acute exacerba-
tion of chronic obstructive pulmonary disease (AECOPD); Respiratory failure; Curative effect
·论 著·
6350.2016.15.011