摘要
目的探讨纤维支气管镜肺泡灌洗(BAL)术辅助机械通气对肺癌术后感染患者近期疗效、病原菌转阴率及实验室指标的影响。方法选取平湖市第一人民医院2014年10月至2017年10月收治的肺癌术后感染患者共110例,采用随机抽签法分为对照组(55例)和观察组(55例),分别采用机械通气和在此基础上加用BAL术治疗;比较两组患者近期疗效、病原菌转阴率、治疗前后呼吸力学指标和炎性细胞因子水平。结果对照组、观察组近期总有效率分别为72.73%、94.54%,对照组、观察组病原菌转阴率分别为72.73%、96.36%,观察组近期疗效和病原菌转阴率均显著优于对照组(χ^2=9.87、10.07,均P<0.05);对照组患者治疗后气道阻力(Raw)、气道峰压力(PIP)及肺顺应性(Cdyn)分别为(12.26±1.87)cmH2O、(22.36±3.14)cmH2O和(25.96±6.95)cmH2O,观察组患者治疗后Raw、PIP及Cydn分别为(8.15±1.33)cmH2O、(14.15±2.29)cmH2O及(33.27±8.09)cmH2O,观察组患者治疗后呼吸力学指标均显著优于治疗前、对照组治疗后(t=4.98、6.44、4.67,3.19、3.56、3.30,均P<0.05);对照组患者治疗后高敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-8及降钙素原(PCT)水平分别为(63.01±15.42)mg/L、(24.12±4.75)ng/L、(142.54±20.40)ng/L、(20.77±4.15)ng/L,观察组患者治疗后hs-CRP、TNF-α、IL-8及PCT水平分别为(48.43±11.20)mg/L、(11.05±2.42)ng/L、(96.72±12.09)ng/L、(14.26±2.33)ng/L,观察组患者治疗后炎性细胞因子水平均显著低于治疗前、对照组治疗后(t=3.89、3.44、4.16、4.95,2.67、2.51、3.17、3.46,均P<0.05)。结论BAL术辅助机械通气用于肺癌术后感染患者可有效控制呼吸道症状,加快病原菌清除,改善呼吸力学指标,并有助于下调炎性细胞因子水平。
ObjectiveTo investigate the influence of bronchoalveolar lavage (BAL) combined with mechanical ventilation on short-term clinical effect, pathogenic bacteria conversion rate and laboratory index of patients with lung cancer and infection after operation.MethodsFrom October 2014 to October 2017, 110 patients with lung cancer and infection after operation in the First People's Hospital of Pinghu were chosen and randomly divided into two groups, with 55 patients in each group.The control group received mechanical ventilation, and the observation group received BAL combined with mechanical ventilation.The short-term clinical effect, pathogen clearance rate, the levels of respiratory mechanics index and inflammatory cytokines before and after treatment of the two groups were compared.ResultsThe short-term effective rates of the control group and the observation group were 72.73%, 94.54%, respectively.The pathogen clearance rates of the control group and the observation group were 72.73%, 96.36%, respectively.The short-term effective rate and pathogen clearance rate of the observation group were significantly higher than those of the control group(χ^2=9.87, 10.07, all P<0.05). The levels of Raw, PIP and Cydn of the observation group after treatment were (8.15±1.33)cmH2O, (14.15±2.29)cmH2O, (33.27±8.09)cmH2O, respectively, which were significantly better than before treatment and those of the control group[(12.26±1.87)cmH2O, (22.36±3.14)cmH2O, (25.96±6.95)cmH2O](t=4.98, 6.44, 4.67, 3.19, 3.56, 3.30, all P<0.05). The levels of hs-CRP, TNF-α, IL-8 and PCT of the observation group after treatment were (48.43±11.20)mg/L, (11.05±2.42)ng/L, (96.72±12.09)ng/L, (14.26±2.33)ng/L, respectively, which were significantly better than before treatment and those of the control group[(63.01±15.42)mg/L, (24.12±4.75)ng/L, (142.54±20.40)ng/L, (20.77±4.15)ng/L](t=3.89, 3.44, 4.16, 4.95, 2.67, 2.51, 3.17, 3.46, all P<0.05).ConclusionBAL combined with mechanical ventilation in the treatment of patients with lung cancer and infection after operation can efficiently control the respiratory symptoms, accelerate the removal process of pathogenic bacteria, improve the respiratory mechanics and is helpful to reduce the levels of inflammatory cytokines.
作者
宋春炳
李贞
Song Chunbing;Li Zhen(Department of Respiratory Diseases,the First People's Hospital of Pinghu ,Pinghu ,Zhejiang 314200,China)
出处
《中国基层医药》
CAS
2019年第1期33-36,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
支气管肺泡灌洗
无创性通气
肺肿瘤
呼吸道感染
C反应蛋白质
肿瘤坏死因子α
白细胞介素8
降钙素
Bronchoalveolar lavage
Noninvasive ventilation
Lung neoplasms
Respiratory tract infection
C-reactive protein
Tumor necrosis factor alpha
Interleukin-8
Calcitonin
