摘要
目的探究支气管镜吸痰联合肺泡灌洗治疗重症肺炎并发呼吸衰竭患者的疗效及对临床肺部感染评分(CPIS评分)、血清炎性指标的影响。方法66例重症肺炎并发呼吸衰竭患者,根据治疗方案的差异分为对照组和观察组,各33例。对照组采取肺泡灌洗治疗,观察组采取支气管镜吸痰联合肺泡灌洗治疗。比较两组治疗前后CPIS评分、血气指标、血清炎性指标、肺功能指标及治疗效果。结果两组治疗后体温、白细胞计数、气管分泌物、氧合情况、X线胸片、肺部浸润影的进展情况和气管吸取物培养评分显著低于本组治疗前,且观察组体温、白细胞计数、气管分泌物、氧合情况、X线胸片、肺部浸润影的进展情况和气管吸取物培养评分低于对照组(P<0.05)。两组治疗后动脉血二氧化碳分压显著低于本组治疗前,动脉血氧饱和度、动脉血氧分压均高于本组治疗前,且观察组治疗后动脉血二氧化碳分压显著低于对照组,动脉血氧饱和度、动脉血氧分压均高于对照组(P<0.05)。两组治疗后血清白细胞介素-6、肿瘤坏死因子-α、超敏C反应蛋白水平均低于本组治疗前,且观察组治疗后血清白细胞介素-6(15.85±2.72)ng/L、肿瘤坏死因子-α(63.76±5.61)ng/L、超敏C反应蛋白(32.86±3.93)mg/L均低于对照组的(22.73±3.31)ng/L、(85.59±7.23)ng/L、(50.25±6.70)mg/L(P<0.05)。两组治疗后第1秒用力呼气容积、呼气流量峰值、用力肺活量均高于本组治疗前,且观察组治疗后第1秒用力呼气容积(1.82±0.24)L、呼气流量峰值(3.37±0.28)L/s、用力肺活量(1.98±0.35)L均高于对照组的(1.45±0.26)L、(2.84±0.21)L/s、(1.58±0.29)L(P<0.05)。观察组治疗总有效率90.91%显著高于对照组的63.64%(P<0.05)。结论支气管镜吸痰联合肺泡灌洗能够提高重症肺炎并发呼吸衰竭患者的治疗效果,降低患者CPIS评分及血清炎性指标水平,有助于肺功能早日恢复正常水平。
Objective To explore the efficacy of bronchoscopic suction combined with bronchoalveolar lavage on severe pneumonia complicated with respiratory failure and its influence on clinical pulmonary infection score(CPIS)and serum inflammatory markers.Methods 66 patients with severe pneumonia complicated with respiratory failure were divided into a control group and an observation group according to the difference of treatment plan,with 33 cases in each group.The control group was treated with bronchoalveolar lavage,and the observation group was treated with bronchoscopic suction combined with bronchoalveolar lavage.The CPIS score,blood gas index,serum inflammatory markers and lung function before and after treatment,and therapeutic effect were compared between the two groups.Results After treatment,the scores of body temperature,white blood cell count,tracheal secretions,oxygenation,chest X-ray,progression of lung infiltration and tracheal aspirate culture in both groups were significantly lower than those before treatment in this group;the scores of body temperature,white blood cell count,tracheal secretions,oxygenation,chest X-ray,progression of lung infiltration and tracheal aspirate culture in the observation group were lower than those in the control group(P<0.05).After treatment,the arterial partial pressure of carbon dioxide in both groups was significantly lower than that before treatment in this group,and the arterial oxygen saturation and arterial partial pressure of oxygen were higher than those before treatment in this group;the arterial partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group,and the arterial oxygen saturation and arterial partial pressure of oxygen in the observation group were higher than those in the control group(P<0.05).After treatment,the serum levels of interleukin-6,tumor necrosis factor-αand hypersensitive C-reactive protein in both groups were lower than those before treatment in this group;the observation group had serum interleukin-6 of(15.85±2.72)ng/L,tumor necrosis factor-αof(63.76±5.61)ng/L,and hypersensitive C-reactive protein of(32.86±3.93)mg/L,which were lower than(22.73±3.31)ng/L,(85.59±7.23)ng/L,and(50.25±6.70)mg/L in the control group(P<0.05).After treatment,the forced expiratory volume in one second,peak expiratory flow and forced vital capacity in both groups were higher than those before treatment in this group;the forced expiratory volume in one second in the observation group was(1.82±0.24)L,the peak expiratory flow was(3.37±0.28)L/s and the forced vital capacity was(1.98±0.35)L,which were higher than(1.45±0.26)L,(2.84±0.21)L/s and(1.58±0.29)L in the control group(P<0.05).The total effective rate of 90.91%in the observation group was significantly higher than 63.64%in the control group(P<0.05).Conclusion Bronchoscopic suction combined with bronchoalveolar lavage can improve the therapeutic effect of patients with severe pneumonia complicated with respiratory failure,reduce the CPIS score and serum inflammatory markers of patients,and help to restore normal lung function as soon as possible.
作者
谢艳军
XIE Yan-jun(Yutai County People's Hospital,Jining 272300,China)
出处
《中国现代药物应用》
2024年第10期13-16,共4页
Chinese Journal of Modern Drug Application
关键词
支气管镜吸痰
肺泡灌洗
重症肺炎
呼吸衰竭
临床肺部感染评分
血清炎性指标
Bronchoscopic aspiration
Bronchoalveolar lavage
Severe pneumonia
Respiratory failure
Clinical pulmonary infection score
Serum inflammatory markers
