2026 年第 3 期 第 21 卷

有创-无创序贯通气联合支气管镜肺泡灌洗对慢性阻塞性肺疾病合并呼吸衰竭患者疗效及膈肌功能的影响

Effect of invasive-noninvasive sequential ventilation combined with bronchoscopic alveolar lavage on efficacy and diaphragmatic function in patients with chronic obstructive pulmonary disease complicated with respiratory failure

作者：刘世洁刘晓黎叶宁孔燕周梅菁

英文作者：Liu Shijie Liu Xiaoli Ye Ning Kong Yan Zhou Meijing

单位：桂林医科大学第一附属医院急诊内科，桂林541001

英文单位：Department of Emergency Internal Medicine the First Affiliated Hospital of Guilin Medical University Guilin 541001 China

关键词：慢性阻塞性肺疾病；呼吸衰竭；支气管镜肺泡灌洗；有创-无创序贯通气

英文关键词：Chronicobstructivepulmonarydisease;Respiratoryfailure;Bronchoscopicalveolarlavage;Invasive-noninvasivesequentialventilation

• 摘要：

• 目的 研究有创-无创序贯通气联合支气管镜肺泡灌洗对慢性阻塞性肺疾病（COPD）合并呼吸衰竭的治疗效果。方法 选取桂林医科大学第一附属医院急诊科和呼吸内科2021年7月至2023年6月收治的COPD合并呼吸衰竭患者58例。采用随机数字表法将患者分为对照组和观察组，各29例。对照组给予有创-无创序贯通气治疗；观察组在对照组治疗方案基础上采用支气管镜肺泡灌洗治疗。比较2组氧化应激指标、免疫功能指标、肺功能指标、膈肌状况、临床疗效及不良反应情况。结果 治疗后，2组超氧化物歧化酶、谷胱甘肽水平均高于治疗前，且观察组均高于对照组，2组丙二醛水平均低于治疗前，且观察组低于对照组（均P＜0.05）。2组CD+3、CD+4水平及CD+4/CD+8比值均高于治疗前，且观察组均高于对照组，CD+8水平均低于治疗前，且观察组低于对照组（均P＜0.05）。2组用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/FVC比值、膈肌增厚分数、膈肌移动度均高于治疗前，且观察组均高于对照组（均P＜0.05）。观察组总有效率高于对照组［86.2%（25/29）比62.1%（18/29）］（P＜0.05）。观察组患者呼吸衰竭纠正时间、机械通气时间及住院时间均短于对照组（均P＜0.05）。治疗期间，2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论 有创-无创序贯通气联合支气管镜肺泡灌洗可显著提高COPD合并呼吸衰竭患者的治疗效果，改善氧化应激及免疫指标，促进膈肌功能恢复，且安全性高。

• Objective To investigate the therapeutic effect of invasive-noninvasive sequential ventilation combined with bronchoscopic alveolar lavage on chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods A total of 58 patients with COPD complicated with respiratory failure admitted to the Department of Emergency and Department of Respiratory, the First Affiliated Hospital of Guilin Medical University from July 2021 to June 2023 were enrolled. The patients were divided into the control group and the observation group using the random number table method, with 29 cases in each group. The control group was treated with invasive-noninvasive sequential ventilation alone, while the observation group was treated with bronchoscopic alveolar lavage on the basis of the control group′s regimen. Oxidative stress indexes, immune function indexes, pulmonary function indexes, diaphragmatic status, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the levels of superoxide dismutase and glutathione in both groups were significantly higher than those before treatment, and the levels in the observation group were significantly higher than those in the control group; the malondialdehyde levels in both groups were significantly lower than those before treatment, and the level in the observation group was significantly lower than that in the control group (all P<0.05). The levels of CD+3, CD+4, and the CD+4/CD+8 ratio in both groups were higher than those before treatment, and the indexes in the observation group were significantly higher than those in the control group; the CD+8 levels in both groups were lower than those before treatment, and the level in the observation group was significantly lower than that in the control group (all P<0.05). The forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, diaphragm thickening fraction and diaphragm excursion in both groups were significantly higher than those before treatment, and the indexes in the observation group were significantly higher than those in the control group (all P<0.05). The total effective rate of the observation group was significantly higher than that of the control group ［86.2%(25/29) vs 62.1%(18/29)］(P<0.05). The time to respiratory failure correction, mechanical ventilation time and length of hospital stay in the observation group were significantly shorter than those in the control group (all P<0.05). During treatment, there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Invasive-noninvasive sequential ventilation combined with bronchoscopic alveolar lavage can significantly improve the therapeutic effect in patients with COPD complicated with respiratory failure, ameliorate oxidative stress and immune indexes, promote the recovery of diaphragmatic function, with high safety.