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目的观察双水平无创正压通气(BiPAP)联合支气管肺泡灌洗术治疗在慢性阻塞性肺疾病急性加重(AECOPD)并呼吸衰竭伴轻、中度意识障碍患者中的疗效。方法对入选的30例伴意识障碍和30例不伴有意识障碍的AECOPD并呼吸衰竭患者,在年龄、性别、病程、体质量状况相似情况下随机分为治疗组和对照组,两组患者均无机械通气禁忌证,在接受常规抗炎、平喘药物治疗的同时进行BiPAP治疗,治疗组采用BiPAP治疗的同时配合纤维支气管镜肺泡灌洗治疗,观察两组治疗前后昏迷指数评分、血气变化、有效率。结果治疗组30例中,经BiPAP配合纤维支气管镜肺泡灌洗治疗有效22例,有效率73.3%;对照组30例中,BiPAP有效21例,有效率70%,两组对比差异无统计学意义(P>0.05)。结论 AECOPD并呼吸衰竭伴意识障碍不是BiPAP的禁忌证,BiPAP联合纤维支气管镜肺泡灌洗治疗对意识障碍的患者同样可以首选BiPAP治疗,在进行BiPAP治疗之前进行纤维支气管镜肺泡灌洗术,可以获得与神志清醒患者相似的疗效。
Objective To observe the efficacy of bi-level noninvasive positive pressure ventilation (BiPAP) combined with bronchoalveolar lavage in patients with acute obstructive pulmonary disease (AECOPD) and respiratory failure with mild to moderate disturbance of consciousness. Methods Thirty patients with AECOPD and respiratory failure who were not associated with disturbance of consciousness were randomly divided into treatment group and control group with similar age, gender, course of disease and body weight. The patients in both groups had no symptoms Mechanical ventilation contraindications, while receiving conventional anti-inflammatory, antiasthmatic drugs BiPAP treatment at the same time, the treatment group with BiPAP treatment combined with bronchoscopic alveolar lavage treatment, the two groups were observed before and after the coma index score, blood gas changes, there effectiveness. Results Among the 30 cases in the treatment group, 22 cases were treated with BiPAP and broncho-alveolar lavage, and the effective rate was 73.3%. Among the 30 cases in the control group, BiPAP was effective in 21 cases, with an effective rate of 70%. There was no significant difference between the two groups (P> 0.05). Conclusions AECOPD with respiratory failure and disturbance of consciousness is not a contraindication to BiPAP. BiPAP and broncho-alveolar lavage may be the first choice of BiPAP in patients with impaired consciousness, and bronchoscopic alveolar lavage may be obtained before the treatment of BiPAP Similar effects with conscious patients.