无创正压通气联合纤维支气管镜吸痰和(或)镇静剂治疗肺心病并肺性脑病.docVIP

无创正压通气联合纤维支气管镜吸痰和(或)镇静剂治疗肺心病并肺性脑病 　　作者：刘文铠　　作者单位：广东省汕头市潮南区人民医院, 广东 汕头 515000 　　【摘要】 目的：探讨无创正压通气(NPPV)联合镇静剂和(或)纤维支气管镜〔纤支镜)吸痰治疗肺心病并肺性脑病患者的疗效和安全性。方法：实验组 22例，男13例，女9例，平均年龄(71.2±4.7)岁，肺心病并肺性脑病患者在常规治疗的基础上，应用NPPV联合纤支镜检查行深部痰细菌培养和清除分泌物，并依据病情必要时予镇静剂。对照组为同期达到同样标准的患者25例，男16例，女9例，平均年龄(70.6±5.3)岁。结果：实验组患者均能进行NPPV治疗，通气前后PaCO2，分别为(11.03±2.12)kPa和(7.65±1.69)　kPa，　PaO2，为(7.82±1.88)kPa和(11.15±2.08)kPa，有显著改善(P0.01);实验组患者均行纤支镜吸痰并全部取得了合格的深部痰标本，操作过程无并发症;与对照组比较，实验组的痰菌阳性率(73.9%与32%)、插管率(30.4%与60.0%)、病死率(21.7%与52.0%)、住院天数(21.6±7.2)d与(34.3±12.3)d均有显著差异(P0.01)。实验组有10例患者接受镇静剂治疗。结论：NPPV联合镇静剂和(或)纤支镜吸痰治疗老年肺心病并肺性脑病患者的效果良好;应用镇静剂时，应做好机械通气的准备。 　　【关键词】 通气机,支气管镜检查,肺心病 　　Abstract：Objective: To study the safety and effect of noninvasive positive pressure ventilation (NIPPV) combined bronchoscope sputum aspiration with sedative in treating pulmonary heart disease complicated with pulmonary encephalopathy. Method: The patients in experiment group (22 cases )who were with pulmonary heart disease complicated with pulmonary encephalopathy were treated with on the basis of NIPPV combined bronchoscope sputum aspiration cultured and clearing secretion traditional therapy.the sedative were given according to the symptom, 25 cases (male 16, female 9 cases ) in control group. Result : The experiment treated with NPPV. The level of PaCO2 and PaO2 before and after ventilation was 11.03±2.12kPa, 7.65±1.69kPa; and 7.82±1.88kPa, 11.15±2.08kPa, respectively. Theres significant difference (P0.01).Theres no complication during bronchoscope sputum aspiration with qualified samples. The positive rate of sputum germ, intubal rate, mortality rate, and inhospitality days in experiment group and control group was 73.9%, 32%; 30.4%, 60%; 21.7%, 52.0%; 21.6±7.2 days, 34.3±12.3 days respectively, no difference (P0.01). 10 cases were accepted sedative in experiment group.Conclusion:Its better effective to treat aged pulmonary heart disease complicated with pulmonary encephalopathy with NIPPV combined sedative with bronch