目的 应用支气管肺泡灌洗技术(broncho-alveolar lavage，BAL)对重症肺部感染呼吸衰竭行机械通气治疗的患者进行诊治，观察临床应用价值及对病原学诊断的意义，及安全性观察。方法 行BAL的观察组65例，对照组60例。通过比较观察组与对照组治疗前后有效率、呼吸力学指标、氧合指数(PO₂/FiO₂)改善、机械通气时间及脱机成功率、入住ICU时间等差异衡量BAL的作用及并发症情况。结果 两组总有效率比较差异有统计学意义(92.3% vs 80%，P＜0.05);观察组血气变化、呼吸力学改善差异有统计学意义(P<0.01)、肺部感染控制窗时间、机械通气时间[(9.5±4.6)d vs (12.5±5.8)d，P＜0.01]及入住ICU时间[(17.5±7.2)d vs (23.4±8.8)d，P＜0.05]优于对照组;观察组脱机成功率差异有统计学意义(93.84% vs 80%，P＜0.05)。结论 BAL对重症肺部感染行机械通气的患者，能有效清除滞留于呼吸道的不良物质，改善肺部的呼吸力学、氧合情况，无严重并发症。有助于病原学诊断、选择有效抗生素，提高机械通气成功率，缩短病期，在危重患者的诊疗中有较高的价值。是安全、有效的，值得临床推广。

Objective Broncho-alveolar lavage (BAL) was applied in severe pulmonanyinfectionpatients with mechanical ventilation to observe its clinical applications. Methods Clinical application of 125 critical patients were divided into observation group(65) and control group(60). The patients in both groups were accepted anti-infection,atomization inhalation and other supportive treatments.The patients in the observation group were treated with BAL,and the patients in the control group were accepted routine treatment.Thetherpeate effects in the 2 groups were evaluatedand compared. Result The recovery rate and effective rate were higher (92.3% vs 80%,P<0.05)PO₂、PO₂/FiO₂、Cdynwasincreased,PIP、Raw decreased in observation group than that in control group, P＜0.01. mechanical ventilation time was shorter [(9.5±4.6)d vs (12.5±5.8)d,P＜0.01]; length of stay in ICU also shorter [(17.5±7.2)d vs (23.4±8.8)d,P＜0.01], in observation group than control group no serious complications happened. Conclusions Fiberoptic bronchoscopy with BAL can effectively for Severepulmonany infection patients needing mechanical vesigntilation, and is helpful to make etiological diagnosis, select effective antibiotics, improve the success rate of mechanical ventilation, and shorten the duration of disease. BAL plays an important role in diagnosis and treatment of critical patients and safety.