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目的探讨旁路支气管肺泡灌洗术(BAL)治疗重度急性有机磷农药中毒(SAOPP)合并呼吸衰竭的临床疗效。方法选取2012年5月至2015年12月在重症医学科(ICU)治疗的SAOPP合并呼吸衰竭患者37例为观察组,在常规治疗的基础上给予旁路BAL。选取2009年1月至2012年4月ICU治疗的相同条件的患者37例作为对照组。比较两组患者住院第5、10、15天住院例数、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、气道峰压(PIP)、氧合指数、阿托品用量的变化;分析观察组在灌洗前后pH值、PaO_2、PaCO_2、PIP、氧合指数的变化。结果观察组住院第5、10天,PaO_2、氧合指数明显高于对照组(P<0.05),PaCO_2、PIP、阿托品用量明显低于对照组(P<0.05);观察组灌洗后pH值、PaO_2、PaCO_2、PIP、氧合指数变化与灌洗前比较差异有统计学意义(P<0.05);观察组第10天住院例数较对照组明显减少(P<0.05)。结论旁路BAL在治疗SAOPP合并呼吸衰竭患者时效果显著。
Objective To investigate the clinical effect of bypass bronchoalveolar lavage (BAL) on severe acute organophosphorus pesticide poisoning (SAOPP) combined with respiratory failure. Methods Thirty-seven patients with SAOPP and respiratory failure who were treated in intensive care unit (ICU) from May 2012 to December 2015 were selected as the observation group, and BAL was given on the basis of routine treatment. 37 patients with the same conditions of ICU treatment from January 2009 to April 2012 were selected as the control group. The changes of inpatient number, PaO_2, PaCO_2, peak airway pressure (PIP), oxygenation index and the amount of atropine on the 5th, 10th and 15th day after hospitalization were compared between the two groups The changes of pH value, PaO_2, PaCO_2, PIP and oxygenation index in observation group before and after lavage were analyzed. Results The PaO2, oxygenation index of the observation group were significantly higher than those of the control group (P <0.05), and the dosage of PaCO_2, PIP and atropine was significantly lower than the control group (P <0.05) , PaO2, PaCO2, PIP and oxygenation index were significantly different from those before the lavage (P <0.05). The number of hospitalization on the 10th day in the observation group was significantly lower than that in the control group (P <0.05). Conclusion Bypass BAL is effective in treating patients with SAOPP complicated with respiratory failure.