摘要
目的探讨支气管肺泡灌洗术(BAL)对卒中机械通气并发重症肺炎患者的治疗效果。方法前瞻性纳入2012年1月至2015年12月收治的68例接受有创机械通气的卒中并发重症肺炎患者,按照随机数字表分为研究组(34例)和对照组(34例),对照组采取治疗原发病、抗感染、常规吸痰、机械辅助排痰及对症支持等治疗,研究组在对照组基础上加用纤维支气管镜(以下简称纤支镜)行BAL治疗,比较两组患者治疗前和治疗后3 d氧合指数、气道峰压的变化、治疗前痰细菌培养阳性率和治疗后7 d痰细菌培养转阴率、抗生素使用时间、机械通气时间及平均重症监护室(ICU)住院时间等指标。结果 (1)研究组和对照组治疗前氧合指数、气道峰压比较[氧合指数:(148±31)比(151±29),气道峰压:(32±5)cm H_2O比(31±5)cm H_2O,t值分别为0.35和0.38],差异无统计学意义(均P>0.05),治疗后3 d,研究组氧合指数升高较对照组更为明显[(213±22)比(186±25)],差异有统计学意义(t=4.70,P<0.01),但两组间气道峰压比较[(21±4)cm H_2O比(22±5)cm H_2O],差异无统计学意义(t=0.96,P>0.05);(2)研究组治疗前痰细菌培养阳性率和治疗后7 d痰细菌培养转阴率明显高于对照组[痰细菌培养阳性率:82.4%(28/34)比47.1%(16/34),治疗7 d后痰细菌培养转阴率89.3%(25/28)比56.2%(9/16),差异均有统计学意义(χ2值分别为9.27和5.01,均P<0.05);(3)研究组抗生素使用时间、机械通气时间及平均ICU住院时间与对照组相比,均明显降低[抗生素使用时间:(9±3)d比(13±3)d、机械通气时间:(13±3)d比(17±3)d、平均ICU住院时间:(17±6)d比(22±6)d],差异均有统计学意义(t值分别为4.74、5.17、4.21,均P<0.01)。结论对机械通气的卒中并发重症肺炎患者行BAL治疗,能提高氧合指数和痰标本转阴检出率、减少使用抗生素、机械通气及平均ICU住院时间。
Objective To investigate the therapeutic effect of bronchoalveolar lavage （BAL） on stroke patients complicated with severe pneumonia of mechanical ventilation. Methods From January 2012 to December 2015,68 consecutive stroke patients complicated with severe pneumonia of invasive mechanical ventilation were enrolled prospectively. They were divided into either a research group （ n = 34） or a control group （ n = 34） according to the random number table method. The control group was treated by using the primary disease, anti-infection, conventional sputum suction, mechanic auxiliary expectoration, and symptomatic support. On the basis of the control group, the research group was added with the fiber bronchoscopy （briefly bronchoscopy） for the treatment of BAL. The indicators such as oxygenation indices at day 3 before and after treatment, peak airway pressure changes, positive rate of sputum culture before treatment, and sputum culture negative rate at day 7 after treatment, duration of using antibiotics, mechanical ventilation time, and average length of stay in intensive care unit （ICU） were compared in both groups. Results （ 1 ） There were no significant differences in the comparison of oxygenation index and peak airway pressure （ oxygenation index, 148± 31 vs. 151 ± 29, peak airway pressure, 3 2 ± 5 cmH20 vs. 31 ±5 cmH20;t = 0.35 and 0.38 respectively） before treatment between the research group and the control group （ all P 〉 0.05 ）. The oxygenation index at day 3 after treatment in the research group increased more significantly than that in the control group （213 ±22 vs. 186 ±25）. There was significant difference （t = 4. 70, P 〈 0. 01 ）. However, there was no significant difference in peak airway pressure between the 2 groups （21±4cmH20 vs. 22±5 cmH2O;t =0.96,P 〉0.05）. （2） The sputum bacterial culture positive rate before treatment in the research group and the sputum bacterial culture negative rate at day 7 d after treatment were significantly higher than those of the control group （ sputum bacterial culture positive rate ： 82.4% （28/34） vs. 47.1% （16/34）. The sputum bacterial culture negative rate at day 7 after treatment was 89.3% （25/28 vs. 56.2% （9/16） ;X2 =9.27 and 5.01 respectively）. There was significant difference （ all P 〈 0.05）. （3） Compared with the control group, the duration of using antibiotics, mechanical ventilation time,and average ICU stay time in the research group were significantly decreased （ duration of using antibiotics：9 ±3 d vs. 13 ± 3 d, mechanical ventilation time： 13 ±3 d vs. 17 ±3 d, and average ICU stay time ： 17 ± 6 d vs. 22 ± 6 d ; t = 4.74,5.17, and 4.21, respectively）. There were significant differences （all P 〈 0.01 ）. Conclusion For stroke patients complicated with severe pneumonia of mechanical ventilation,conducting BAL may increase the oxygenation index and the detection rate of negative sputum specimens and reduce the use of antibiotics, mechanical ventilation, and the average ICU stay time.
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2016年第11期569-574,共6页
Chinese Journal of Cerebrovascular Diseases
基金
广东省自然科学基金(2015A030313735)
广东省科技计划项目(2014A020212651)
关键词
卒中
机械通气
重症肺炎
支气管肺泡灌洗术
疗效
Stroke
Mechanical ventilation
Severe pneumonia
Bronchial alveolar lavage
Therapeutic effect
