摘要
目的分析纤维支气管镜(BFS)肺泡灌洗治疗对重症呼吸机相关性肺炎(VAP)患者感染控制效果、肺功能及炎症反应的影响。方法选取我院2018年12月—2020年12月收治的105例重症VAP,根据不同治疗方法分为研究组52例和对照组53例,研究组在常规治疗基础上予BFS肺泡灌洗治疗,对照组在常规治疗基础上予无菌吸痰管吸痰、肺泡灌洗治疗。比较2组临床疗效、临床相关指标,治疗前后肺功能指标、炎性因子,以及并发症发生情况。结果研究组总有效率明显高于对照组(P<0.05)。研究组感染控制时间、退热时间、机械通气时间短于对照组,治疗后临床肺部感染评分显著低于对照组(P<0.01)。治疗后,2组用力肺活量、最大通气量、肺总量及第1秒用力呼气容积水平均升高,以研究组升高更显著(P<0.05,P<0.01)。治疗后,2组肿瘤坏死因子-α、C反应蛋白、降钙素原及巨噬细胞炎症蛋白-1α水平均降低,且研究组显著低于对照组(P<0.05,P<0.01)。2组并发症发生率比较差异无统计学意义(P>0.05)。结论BFS肺泡灌洗对重症VAP患者感染控制效果确切,可改善患者肺功能并缓解炎症反应程度。
Objective To analyze effects of fiberoptic bronchoscopy(BFS)alveolar lavage on infection control,pulmonary function and inflammatory reaction in patients with severe ventilator-associated pneumonia(VAP).Methods A total of 105 patients with severe VAP admitted between December 2018 and December 2020 were selected and divided into research group(n=52)and control group(n=53)according to different therapeutic methods.Research group was treated with alveolar lavage under fiberoptic bronchoscope on the basis of conventional treatment,while control group was treated with aspiration of sputum using sterile sputum suction tube and alveolar lavage on the basis of conventional treatment.Clinical efficacy,clinical related indexes,pulmonary function indexes,inflammatory factors and incidence rates of complications before and after treatment were compared between two groups.Results The total effective rate in research group was significantly higher than that in control group(P<0.05).Compared with those in control group,infection control time,antipyretic time and duration of mechanical ventilation were significantly shorter,while clinical pulmonary infection score(CPIS)after treatment was significantly lower in research group(P<0.01).After treatment,forced vital capacity,maximal voluntary ventilarion(MVV),total lung volume and forced expiratory volume in one second were significantly increased compared with those before treatment in two groups,and the increased degrees were more obvious in research group(P<0.05,P<0.01).After treatment,levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),procalcitonin and macrophage inflammatory protein-1αwere significantly lower than those before treatment in two groups,and the levels in research group were significantly lower than those in control group(P<0.05,P<0.01).There was no significant difference in incidence rate of complications between two groups(P>0.05).Conclusion BFS alveolar lavage has a definite effectiveness on infection control in treatment of patients with severe VAP,and it may improve pulmonary function and alleviate degree of inflammatory reaction.
作者
肖永贵
米红明
汤晓瑞
XIAO Yong-gui;MI Hong-ming;TANG Xiao-rui(Department of Respiratory Medicine,the Second Hospital of Qinhuangdao,Qinhuangdao,Hebei 066600,China;Department of Rehabilitation Medicine,the Second Hospital of Qinhuangdao,Qinhuangdao,Hebei 066600,China)
出处
《解放军医药杂志》
CAS
2022年第3期45-48,共4页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
秦皇岛市科学技术研究与发展计划项目(201805A125)。
关键词
肺炎
呼吸机相关性
支气管镜
支气管肺泡灌洗
感染控制
肺活量
肿瘤坏死因子-Α
C反应蛋白
Pneumonia,ventilator-associated
Bronchoscopes
Bronchoalveolar lavage
Infection control
Vital capacity
Tumor necrosis factor-α
C-reactive protein
