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
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- 文章访问数: 193
- HTML全文浏览量: 81
- PDF下载量: 1
- 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

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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。

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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。

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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。

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