床旁电子支气管镜肺泡灌洗在重症肺部感染治疗中的应用

刘善青; 王楠; 张妍蓓

doi:10.16766/j.cnki.issn.1674-4152.002491

床旁电子支气管镜肺泡灌洗在重症肺部感染治疗中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002491

1.
安徽医科大学第四附属医院重症医学科，安徽合肥 230000
2.
安徽医科大学第一附属医院老年呼吸内科，安徽合肥 230022

基金项目:

安徽高校自然科学研究项目 KJ2018A0208

详细信息

通讯作者:
张妍蓓, E-mail: zhangyanbei03@yahoo.com.cn

中图分类号: R563.1R563.8
计量
- 文章访问数: 319
- HTML全文浏览量: 118
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-03
- 网络出版日期: 2022-09-21

Application of bedside electronic bronchoscopic alveolar lavage in the treatment of severe pulmonary infection

1.
Intensive Care Unit, the Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, China

摘要

摘要: 目的探讨电子支气管镜肺泡灌洗治疗重症肺部感染的效果。方法选取2018年12月—2021年1月安徽医科大学第四附属医院重症医学科收治的重症肺部感染并发呼吸衰竭患者40例，按照治疗方法分为观察组和对照组，每组20例。对照组采用抗感染、机械通气、吸痰等常规治疗，观察组在常规治疗基础上加用电子支气管镜肺泡灌洗治疗，观察2组临床疗效、血气分析指标、炎症指标及操作安全性。结果观察组疗效优于对照组(Z=2.054, P=0.040)。治疗后，与对照组比较，观察组动脉血氧分压[(113.88±17.52)mm Hg vs. (91.36±16.70)mm Hg，P＜0.001，1 mm Hg=0.133 kPa]和氧合指数[(308.42±55.25)mm Hg vs. (258.43±64.02)mm Hg，P=0.012]更高, 动脉血二氧化碳分压[(34.33±3.92)mm Hg vs. (37.37±2.72)mm Hg，P=0.007]更低。观察组的白细胞计数[(7.42±1.82)×10⁹/L]、超敏C反应蛋白[22.43(11.66，31.02)mg/L]、降钙素原[0.32(0.14, 0.44) ng/mL]均低于对照组[(9.66±2.57)×10⁹/L，44.79(16.03，87.01)mg/L，0.73(0.17, 2.29)ng/mL，均P＜0.05]。观察组支气管肺泡灌洗操作过程中未出现严重不良反应。结论支气管镜肺泡灌洗操作安全，可改善患者肺功能，对肺部感染控制疗效显著。
- 肺部感染 /
- 支气管镜肺泡灌洗 /
- 血气分析 /
- 炎症指标
Abstract: Objective To investigate the effect of electronic bronchoscopic alveolar lavage in the treatment of severe pneumonia. Methods Forty patients with severe pulmonary infection complicated with respiratory failure admitted to the Intensive Care Department of the Fourth Affiliated Hospital of Anhui Medical University from December 2018 to January 2021 were selected. They were divided into the observation group and control group according to treatment methods, with 20 patients in each group. The control group was treated with anti-infection, mechanical ventilation, sputum aspiration and other conventional treatments, whereas the observation group was treated with electronic bronchoscopic alveolar lavage on the basis of conventional treatment. The clinical efficacy, blood gas analysis, inflammatory indicators and operation safety of the two groups were observed. Results The curative effect of the observation group was higher than that of the control group(Z=2.054, P=0.040). After treatment, the observation group had higher arterial partial pressure of oxygen [(113.88±17.52) mm Hg vs. (91.36±16.70) mm Hg, P < 0.001, 1 mm Hg=0.133 kPa] and oxygenation index [(308.42±55.25) mm Hg vs. (258.43±64.02) mm Hg, P=0.012] and lower arterial partial pressure of carbon dioxide [(34.33±3.92) mm Hg vs. (37.37±2.72) mm Hg, P=0.007] than the control group. The white blood cell count [(7.42±1.82)×10⁹/L], high-sensitivity C-reactive protein [22.43 (11.66, 31.02) mg/L] and procalcitonin [0.32 (0.14, 0.44) ng/mL] in the observation group were lower than those in the control group [(9.66±2.57)×10⁹/L, 44.79 (16.03, 87.01) mg/L and 0.73 (0.17, 2.29)ng/mL, respectively, all P < 0.05]. There were no serious adverse reactions during bronchoalveolar lavage in the observation group. Conclusion Bronchoscopic alveolar lavage is safe, can improve lung function and has significant effect on the control of pulmonary infection.
- Pulmonary infection /
- Bronchoscopic alveolar lavage /
- Blood gas analysis /
- Inflammatory markers

HTML全文

表 1 2组重症肺部感染患者临床疗效比较[例(%)]

Table 1. Comparison of clinical efficacy between two groups of patients with severe pulmonary infection [cases (%)]

组别	例数	显效	有效	无效	总有效
对照组	20	11(55.0)	3(15.0)	6(30.0)	14(70.0)
观察组	20	17(85.0)	2(10.0)	1(5.0)	19(95.0)
注：2组临床疗效比较，Z=2.054，P=0.040。

下载: 导出CSV

表 2 2组重症肺部感染患者PaO₂、PaCO₂及OI水平比较(x±s，mm Hg)

Table 2. Comparison of PaO₂, PaCO₂ and OI levels between two groups of patients with severe pulmonary infection

组别	例数	PaO₂		PaCO₂		OI
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	20	80.16±15.46	113.88±17.52^a	40.39±5.86	34.33±3.92^a	198.90±50.44	308.42±55.25^a
对照组	20	79.83±14.44	91.36±16.70^a	42.32±5.67	37.37±2.72^a	202.03±44.56	258.43±64.02^a
t值		0.070	4.161	-1.056	-2.855	-0.208	2.644
P值		0.945	＜0.001	0.297	0.007	0.837	0.012
注：与同组治疗前比较，^aP < 0.05。1 mm Hg=0.133 kPa。

下载: 导出CSV

表 3 2组重症肺部感染患者治疗前后炎症相关指标比较

Table 3. Comparison of inflammation-related indexes between the two groups of patients with severe pulmonary infection before and after treatment

组别	例数	WBC(x±s，×10⁹/L)		hs-CRP[M(P₂₅, P₇₅)，mg/L]		PCT[M(P₂₅, P₇₅)，ng/mL]
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	20	11.97±3.55	7.42±1.82^b	125.48(81.90，165.69)	22.43(11.66，31.02)^b	1.54(0.57, 4.05)	0.32(0.14, 0.44)^b
对照组	20	13.80±5.13	9.66±2.57^b	78.77(44.61，217.01)	44.79(16.03，87.01)^b	2.29(1.21, 5.64)	0.73(0.17, 2.29)^b
统计量		-1.305^a	-3.172^a	1.353^c	-2.002^c	-0.987^c	-2.111^c
P值		0.200	0.003	0.176	0.045	0.323	0.035
注：^a为t值，^c为Z值；与同组治疗前比较，^bP < 0.05。

下载: 导出CSV

参考文献(22)

[1]	张静, 苏江华, 杨会芳, 等. 支气管肺泡灌洗辅助治疗重症肺炎合并呼吸衰竭的疗效及对炎性因子、肺功能的影响[J]. 解放军医药杂志, 2021, 33(4): 59-64. https://www.cnki.com.cn/Article/CJFDTOTAL-HBGF202104015.htm ZHANG J, SU J H, YANG H F, et al. Effectiveness of bronchoalveolar lavage in adjunctive treatment of patients with severe pneumonia complicated with respiratory failure and its effect on inflammatory factors and d pulmonary function[J]. Medical & Pharmaceutical Journal of Chinese People ' s Liberation Army, 2021, 44(4): 59-64. https://www.cnki.com.cn/Article/CJFDTOTAL-HBGF202104015.htm
[2]	赖丽. 纤维支气管镜支气管肺泡灌洗治疗重症肺部感染疗效观察[J]. 吉林医学, 2018, 39(2): 270-271. doi: 10.3969/j.issn.1004-0412.2018.02.028 LAI L. Effect of bronchoalveolar lavage with electronic bronchoscope on severe pulmonary infection[J]. Jilin Medical Journal, 2018, 39(2): 270-271. doi: 10.3969/j.issn.1004-0412.2018.02.028
[3]	袁小丽, 姚秀娟, 刘晓芳, 等. 纤维支气管镜灌洗对重症肺炎患者感染指标的影响和临床疗效[J]. 中国临床医生杂志, 2020, 48(8): 924-927. doi: 10.3969/j.issn.2095-8552.2020.08.014 YUAN X L, YAO X J, LIU X F, et al. Influence and clinical effect of fiberoptic bronchoscopy lavage on infection index in patients with severe pneumonia[J]. Chinese Clinical Doctor, 2020, 48(8): 924-927. doi: 10.3969/j.issn.2095-8552.2020.08.014
[4]	张霞辉, 蔡龙, 陈涛. 纤维支气管镜肺泡灌洗治疗重症肺炎伴呼吸衰竭对患者血气及炎症指标的影响[J]. 当代医学, 2018, 24(5): 66-67. https://www.cnki.com.cn/Article/CJFDTOTAL-DDYI201805028.htm ZHANG X H, CAI L, CHEN T. Effect of bronchobronchoscopic alveolar lavage on blood gas and inflammation in patients with severe pneumonia complicated with respiratory failure[J]. Contemporary Medicine, 2018, 24(5): 66-67. https://www.cnki.com.cn/Article/CJFDTOTAL-DDYI201805028.htm
[5]	熊巍鹏, 蒋在慧. 经纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染治疗中的临床作用[J]. 实用心脑肺血管病杂志, 2021, 29(S1): 60-62. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL2021S1024.htm XIONG W P, JIANG Z H. Clinical effect of sputum aspiration via fiberoptic bronchoscope combined with alveolar lavage in the treatment of severe pulmonary infection[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2021, 29(S1): 60-62. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL2021S1024.htm
[6]	HAN Q, CHEN C, HU H Q, et al. Effect evaluation on use of bedside fiber bronchoscope in treating stroke-associated pneumonia[J]. Top Stroke Rehabil, 2018, 25(6): 459-466.
[7]	高秀峰, 程茜, 黄友明. 支气管镜肺泡灌洗在重症肺部感染应用及灌洗液培养结果分析[J]. 现代医学与健康研究电子杂志, 2019, 3(8): 26-27. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD201908014.htm GAO X F, CHEN Q, HUANG Y M. Application of bronchoscopic alveolar lavage in severe pulmonary infection and analysis of lavage fluid culture results[J]. Modern Medicine and Health Research, 2019, 3(8): 26-27. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD201908014.htm
[8]	邓忠天, 邹兰科, 陈丽娜. 支气管镜在下呼吸道感染病原学诊断中的应用价值[J]. 微创医学, 2021, 16(3): 423-425. https://www.cnki.com.cn/Article/CJFDTOTAL-WCYX202103036.htm DENG Z T, ZOU L K, CHEN L N. Application of bronchoscopy in etiological diagnosis of lower respiratory tract infection[J]. Journal of Minimally Invasive Medicine, 2021, 16(3): 423-425. https://www.cnki.com.cn/Article/CJFDTOTAL-WCYX202103036.htm
[9]	栾育欣, 唐德军, 徐伟. 经纤维支气管镜肺泡灌洗治疗重症肺炎的临床效果[J]. 临床医学研究与实践, 2019, 4(22): 49-51. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201922020.htm LUAN Y X, TANG D J, XU W. Clinical efficacy of bronchoalveolar lavage with fiberoptic bronchoscope in the treatment of severe pneumonia[J]. Clinical Medicine, 2019, 8(22): 49-51. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201922020.htm
[10]	马蓉, 马俊, 王熠, 等. 支气管肺泡灌洗治疗重症肺部感染的疗效研究[J]. 现代医药卫生, 2019, 35(5): 734-736. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201905033.htm MA R, MA J, WANG Y, et al. Effect of bronchoalveolar lavage on severe pulmonary infection[J]. Modern Medicine & Health, 2019, 35(5): 734-736. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS201905033.htm
[11]	卢保霞, 陈荣寿, 汪珊, 等. 纤维支气管镜下肺泡灌洗治疗小儿肺炎支原体大叶性肺炎的临床疗效分析[J]. 中华全科医学, 2021, 19(7): 1138-1141. doi: 10.16766/j.cnki.issn.1674-4152.002005 LU B X, CHEN R S, JIANG S, et al. Clinical efficacy of fiberoptic bronchoscopy alveolar lavage in the treatment of Mycoplasma pneumoniae lobar pneumonia in children[J]. Chinese Journal of General Practice, 2021, 19(7): 1138-1141. doi: 10.16766/j.cnki.issn.1674-4152.002005
[12]	邓晓慧, 田巍, 葛晓竹, 等. 纤维支气管镜吸痰联合肺泡灌洗对高龄慢性阻塞性肺疾病合并重症肺炎患者的疗效观察[J]. 中国医药, 2021, 16(4): 535-539. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202104013.htm DENG X H, TIAN W, GE X Z, et al. Curative efficacy of fiberoptic bronchoscopy for sputum suction combined with alveolar lavage on elderly patients with chronic obstructive pulmonary disease complicated with severe pneumonia[J]. China Medicine, 2021, 16(4): 535-539. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202104013.htm
[13]	冯文帅. 支气管肺泡灌洗对重症肺部感染患者呼吸力学指标及氧合指数的影响[J]. 中国医学工程, 2019, 27(10): 84-86. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC201910024.htm FENG W S. Effects of bronchoalveolar lavage on respiratory mechanics and oxygenation index in patients with severe pulmonary infection[J]. China Medical Engineering, 2019, 27(10): 84-86. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC201910024.htm
[14]	高庆林, 付瑜. 纤维支气管镜下支气管肺泡灌洗治疗重症肺部感染的临床效果[J]. 中国当代医药, 2019, 26(9): 88-90. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD201909026.htm GAO Q L, FU Y. Clinical effect of bronchoalveolar lavage under fiberoptic bronchoscope in the treatment of severe pulmonary infection[J]. China Modern Medicine, 2019, 26(9): 88-90. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD201909026.htm
[15]	王锋, 刘杰, 黄仲俊. 纤维支气管镜肺泡灌洗治疗重症肺炎的临床效果及其对肺通气功能、血清炎性因子水平的影响[J]. 实用心脑肺血管病杂志, 2018, 26(10): 84-88. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL201810026.htm WANG F, LIU J, HUANG Z J. Clinical Effect of fiberoptic bronchoscopic alveolar lavage on severe pneumonia and the impact on pulmonary ventilation function and serum inflammatory cytokines levels[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2018, 26(10): 84-88. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL201810026.htm
[16]	WANG C Y, YE S, WANG X C, et al. Clinical efficacy and safety of mechanical ventilation combined with fiberoptic bronchoalveolar lavage in patients with severe pulmonary infection[J]. Med Sci Monit, 2019, 25: 5401-5407.
[17]	ANNA S A, HELENA H, MALIN I, et al. Heparin-binding protein, lysozyme, and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients[J]. Am J Transplant, 2018, 18(2): 444-452.
[18]	马叶萍, 严一核, 孙雪东, 等. 重症肺炎肺泡灌洗液的炎症因子表达水平与预后的相关性[J]. 中华医院感染学杂志, 2019, 29(7): 1007-1010. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201907012.htm MA Y P, YAN Y H, SUN X D, et al. Correlation between inflammatory factor expression level in severe pneumococcal alveolar lavage fluid and prognosis[J]. Chinese Journal of Nosocomiology, 2019, 29(7): 1007-1010. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201907012.htm
[19]	吕中, 任波, 戴志辉. 支气管肺泡灌洗在老年慢性阻塞性肺疾病合并重症肺炎患者中的价值研究[J]. 中国现代医学杂志, 2021, 31(12): 23-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY202112005.htm LYU Z, REN B, DAI Z H. The value of bronchoalveolar lavage in elderly patients with COPD and severe pneumonia[J]. China Journal of Modern Medicine, 2021, 31(12): 23-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY202112005.htm
[20]	PING R. Changes and significance of procalcitonin, C-reactive protein, peripheral leukocyte count and prealbumin in patients with severe pneumonia[J]. J Hainan Med Univ, 2018, 24(7): 5-7.
[21]	刘洋, 江威, 韩伦英, 等. PCT、CRP、WBC和N%在细菌感染性疾病中的诊断价值评估[J]. 实用医学杂志, 2018, 34(4): 641-644, 652. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201804031.htm LIU Y, JIANG W, HAN L Y, et al. Evaluation of PCT, CRP, WBC and N% in the diagnosis and treatment of common pathogenic bacteria[J]. The Journal of Practical Medicine, 2018, 34(4): 641-644, 652. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201804031.htm
[22]	陈兆芸. 纤维支气管镜吸痰在重症肺部感染患者中的应用[J]. 黑龙江医药, 2019, 32(3): 639-640. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY201903062.htm CHEN Z Y. Application of bronchoscopic sputum aspiration in patients with severe pulmonary infection[J]. Heilongjiang Medicine Journal, 2019, 32(3): 639-640. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY201903062.htm