摘要
目的探讨纤维支气管镜辅助治疗重症呼吸机相关肺炎的临床价值,为临床提供参考。方法选取2021年1月至2022年6月临沂市中心医院收治的100例重症呼吸机相关肺炎患者为研究对象,按照随机数字表法分为对照组和研究组,各50例。对照组患者采用常规治疗,研究组患者在对照组基础上联合纤维支气管镜肺泡灌洗治疗。比较两组患者临床指标、血气指标、肺通气指标、炎症指标及并发症发生情况。结果研究组患者机械通气时间、肺部感染控制时间、呼吸系统加强护理病房(RICU)留观时间及病愈时间均短于对照组(P<0.05)。治疗后,两组患者气道阻力(Raw)、气道峰压(PIP)水平低于治疗前,肺动态顺应性(Cdyn)水平高于治疗前,且研究组患者Raw、PIP水平低于对照组,Cdyn水平高于对照组(P<0.05)。治疗后,两组患者动脉血氧分压(PaO_(2))水平高于治疗前,动脉血二氧化碳分压(PaCO_(2))水平低于治疗前,且研究组患者PaO_(2)水平高于对照组,PaCO_(2)水平低于对照组(P<0.05)。治疗后,两组患者C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平均低于治疗前,且研究组低于对照组(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论在重症呼吸机相关肺炎患者中采用纤维支气管镜辅助治疗能够促进患者病情缓解,改善血气及肺通气指标,降低体内炎症因子水平,治疗安全性良好,值得临床应用。
Objective To investigate the clinical value of fiberbronchoscope-assisted treatment of severe ventilator-associated pneumonia,and to provide reference for clinic.Methods 100 patients with severe ventilators-associated pneumonia admitted to Linyi Central Hospital from January 2021 to June 2022 were selected as research objects,and were divided into control group and study group according to random number table method,with 50 cases in each group.The control group received conventional treatment,and the study group received combined bronchoscopic alveolar lavage on the basis of the control group.The clinical indexes,blood gas indexes,lung ventilation indexes,inflammation indexes and complications were compared between the two groups.Results The mechanical ventilation time,pulmonary infection control time,respiratory intensive care unit(RICU)observation time and recovery time of patients in the study group were shorter than those in the control group(P<0.05).After treatment,the levels of raw air way(Raw)and peak inspiratory pressure(PIP)in two groups were lower than those before treatment,and the level of dynamic lung compliance(Cdyn)was higher than those before treatment,and the Raw and PIP levels in the study group were lower than those in the control group,and the Cdyn level was higher than that in the control group(P<0.05).After treatment,the level of arterial partial pressure of oxygen(PaO_(2))was higher than those before treatment,and the level of arterial partial pressure of carbon dioxide(PaCO_(2))was lower than those before treatment,and the level of PaO_(2)in the study group was higher than that in the control group,and the level of PaCO_(2)was lower than that in the control group(P<0.05).After treatment,the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in two groups were lower than those before treatment,and the study group was lower than those in the control group(P<0.05).There was no significant difference in the incidence of complications between two groups(P>0.05).Conclusion In patients with severe ventilator-associated pneumonia,fiberbronchoscopy-assisted therapy can promote the remission of the disease,improve the indexes of blood gas and lung ventilation,and reduce the level of inflammation in vivo.The treatment is safe and worthy of clinical application.
作者
许弘邦
宋红磊
王永锋
XU Hongbang;SONG Honglei;WANG Yongfeng(Department of Respiratory and Critical Care Medicine,Linyi Central Hospital,Linyi,276400,Shandong,China)
出处
《大医生》
2023年第11期4-8,共5页
Doctor
关键词
重症呼吸机相关肺炎
纤维支气管镜
炎症水平
并发症
Severe ventilator-associated pneumonia
Fiberbronchoscope
Inflammation levels
Complication
