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目的探讨机械通气必要时联合支气管肺泡灌洗(BAL)在治疗重症哮喘中的作用。方法选择常规治疗后病情缓解不明显的重症哮喘呼吸衰竭患者18例,建立人工气道行机械通气治疗,对24h后气道压力仍偏高者,应用生理盐水经纤支镜行BAL,清除呼吸道痰栓。结果通气24h后,13例气道阻力逐渐下降;另5例PIP仍在55cmH2O以上,行BAL2、24h后,PaO2逐渐升高,PaCO2、PIP逐渐下降,差异有统计学意义(P<0.05);12例成功脱机,脱机后血气分析结果恢复正常,pH、PaO2和PaCO2较插管前有明显改善,差异有统计学意义(P<0.05)。结论在机械通气基础上联合BAL是治疗重症哮喘的有效措施。
Objective To investigate the role of bronchial alveolar lavage (BAL) combined with mechanical ventilation in the treatment of severe asthma when necessary. Methods Eighteen patients with severe asthma respiratory failure who did not relieve their symptoms after conventional treatment were selected. The artificial airway was established and treated with mechanical ventilation. After 24 hours, the airway pressure was still high. BAL was performed with bronchoalveolar lavage with bronchoalveolar lavage bolt. Results The airway resistance gradually decreased in 13 cases after ventilation for 24 hours. The other 5 cases were still above 55cmH2O. PaO2 gradually increased and PaCO2 and PIP decreased gradually after 24 hours of BAL2. The difference was statistically significant (P <0.05). Twelve patients were successfully off-line, blood gas analysis returned to normal after taking off, pH, PaO2 and PaCO2 were significantly improved compared with before intubation, the difference was statistically significant (P <0.05). Conclusion BAL combined with mechanical ventilation is an effective treatment for severe asthma.