临床医学毕业论文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.docVIP

X X 大学毕业论文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姓 名：__________2014年6月25日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 作者：马国忠，刘文铠，林闻雄，吴苏武 【摘要】 目的：探讨无创正压通气(NIPPV)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 25例，在常规治疗的基础上，应用NIPPV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，对治疗前、中、后行实验室指标、生命体征、脉搏、血氧饱和度、血气分析等观察监测。结果：实验组患者均能进行NIPPV治疗，通气前、后PaCO2分别为(11.05±2.14) kPa和(7.85±1.69) kPa，　PaO2分别为(7.81±1.87) kPa和(11.14±2.07) kPa，通气后患者病情有显著改善(P0.01);实验组患者均行纤支镜吸痰并均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(72%vs32%)、插管率(32%vs 60.0%)、病死率(20%vs 52.0%)、住院天数(21.4±7.5)d vs(34.3±12.3) d，差异均有统计学意义(P0.01)。实验组有11例患者接受镇静剂治疗。结论：NIPPV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;镇静剂;肺心病 [ABSTRACT] Objective:To study the safety and effect of noninvasive positive pressure ventilation (NIPPV) combined with sputum aspiration by bronchoscope and /or sedative in treating pulmonary heart disease complicated with pulmonary encephalopathy.Methods: Besides regular treatment,the patients in experiment group (25cases ) with pulmonary heart disease complicated with pulmonary encephalopathy were treated by sputum bacteria culture and secretion clearing by fibre bronchoscope combined with NIPPV.Observed laboratory indexes, body signs, pulse, blood oxygen saturation, blood gas analysis, and so on.Results: All cases in the experiment group were treated with NIPPV successfully. The levels of PaCO2 before and after ventilation were (11.05±2.14) kPa, (7.85±1.68) kPa; and PaO2 were (7.81±1.87) kPa and (11.14±2.07) kPa, respectively. There was significant difference (P0.01).No complication occurred during sputum aspiration and qualified samples were available. The positive rate of sputum germ, intubal rate, mortality rate, and inhospitality days in experiment group and control group was 72%vs 32%, 32%vs 60%, 20%vs 52.0%, (21.4±7.5) d vs (34.3±12.3) d, respectively, with insignificant difference (P0.01). 11 cases were treated with sedative in experiment gro