摘要
目的探讨纤支镜灌洗治疗在机械通气患者肺部感染的应用效果。方法选取2013年6月-2016年6月在医院重症监护室接受机械通气治疗的肺部感染合并呼吸衰竭患者72例,分为观察组和对照组,各36例,对照组常规抗感染、祛痰液、解痉、平喘等综合治疗,观察组患者在此基础上常规给予每日一次纤支镜吸痰及局部支气管肺泡灌洗治疗;观察比较两组患者治疗3d后动脉血气、白细胞计数(WBC)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)变化情况,比较两组患者体温恢复至正常时间、机械通气时间、ICU住院时间以及治疗后的总有效率、满意率。结果治疗3d后,两组患者的PaO_2以及氧合指数都有所上升,观察组高于对照组[(83.23±12.59)mmHg vs(77.45±8.59)mmHg,190.23±21.56vs 168.78±22.59],差异有统计学意义(P<0.05);两组患者的PaCO_2均有所下降,观察组低于对照组[(38.65±7.12)mmHg vs(45.17±6.03)mmHg],差异有统计学意义(P<0.05);两组患者的WBC、hs-CRP及PCT都有所降低,观察组低于对照组(11.74±2.76)×10~9/L vs(13.89±2.15)×10~9/L、(73.26±11.65)mg/L vs(82.13±13.57)mg/L、(0.53±0.39)ng/ml vs(0.92±0.45)ng/ml,两组比较差异有统计学意义(P<0.05);观察组患者的体温恢复至正常时间、机械通气时间、ICU住院时间[(2.78±0.56)d、(9.45±4.38)d、(12.12±3.60)d]都明显短于对照组患者[(4.12±0.92)d、(12.23±5.89)d、(18.23±3.02)d],两组比较差异有统计学意义(P<0.05);观察组患者治疗后的总有效率为97.22%,高于对照组患者治疗后的总有效率72.22%,差异有统计学意义(P<0.05)。结论常规的纤支镜灌洗治疗能够有效改善肺部感染合并呼吸衰竭患者的氧合,减少机械通气时间,效果显著,值得临床推广使用。
OBJECTIVE To explore the effect of fiberoptic bronchoscopy lavage on treatment of mechanical ventilation patients with pulmonary infections.METHODS A total of 72 pulmonary infection patients complicated with respiratory failure who received mechanical ventilation in intensive care unit from Jun 2013 to Jun 2016 were enrolled in the study and divided into the observation group and the control group,with 36 cases in each.The control group was given comprehensive therapies such as conventional anti-infection,expectorant,antispasmodic,and relieving asthma,while the observation group was treated with additional daily Fiberoptic bronchoscopy sputum suction and local bronchoalveolar lavage based on the treatment of the control group.The levels of arterial blood gases,white blood cell （WBC） counts,high-sensitive CRP （hs-CRP）,and procalcitonin （PCT） were observed and compared between the two groups of patients after the treatment for 3 days;the time of body temperature returning to normal,mechanical ventilation duration,length of ICU stay,total effective rate of treatment,and satisfaction were compared between the two groups of patients.RESULTS Both PaO2 and oxygenation index of the two groups of patients were elevated after the treatment for 3 days;the PaO2 of the observation group was （83.23412.59）mmHg,higher than （77.45±8.59）mmHg of the control group,and the oxygenation index of the observation group was 190.23±21.56,significantly higher than 168.78±22.59 of the control group（P〈0.05）.The PaCO2 of the two groups of patients declined,the PaCO2 of the observation group was （38.65 ±7.12）mmHg,lower than （45.17±6.03）mmHg of the control group （P〈0.05）.The levels of WBC,hs-CRP,and PCT of the two groups of patients were reduced and were significantly lower in the observation group than in the control group （11.74±2.76 vs 13.89±2.15,73.26±11.65 vs 82.13± 13.57,0.53±0.39 vs 0.92±0.45）,（P〈0.05）.The time of body temperature returning to normal （2.78 ± 0.56） days,mechanical ventilation duration （9.45±4.38） days,and length of ICU stay （12.12±3.60） days of the observation group were significantly shorter than those of the control group [（4.12±0.92） days,（12.23±5.89） days,（18.23±3.02） days],（P〈0.05）.The total effective rate of treatment of the observation group was 97.22%,significantly higher than 69.44% of the control group（P〈 0.05）.CONCLUSION The conventional fiberoptic bronchoscopy lavage can effectively improve the oxygenation of the pulmonary infection patients complicated with respiratory failure and shorten the mechanical ventilation,with the effect remarkable,and it is worthy to be promoted in the hospital.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第10期2237-2240,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生科技计划基金资助项目(2016KYB308)
关键词
纤支镜灌洗
机械通气
肺部感染
Fiberoptic bronchoscopy lavage
Mechanical ventilation
Pulmonary infection
