[1]刘雪娇,谭晓纯,何 宁.老年重症肺炎患者病原菌分布及支气管镜肺泡灌洗术的治疗效果与安全性[J].新乡医学院学报,2022,39(9):838-841.[doi:10.7683/xxyxyxb.2022.09.008]
 LIU Xuejiao,TAN Xiaochun,HE Ning.Distribution of pathogenic bacteria in elderly patients with severe pneumonia and the therapeutic effect and safety of bronchoscopy alveolar lavage[J].Journal of Xinxiang Medical University,2022,39(9):838-841.[doi:10.7683/xxyxyxb.2022.09.008]
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老年重症肺炎患者病原菌分布及支气管镜肺泡灌洗术的治疗效果与安全性
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年9
页码:
838-841
栏目:
临床研究
出版日期:
2022-09-05

文章信息/Info

Title:
Distribution of pathogenic bacteria in elderly patients with severe pneumonia and the therapeutic effect and safety of bronchoscopy alveolar lavage
作者:
刘雪娇谭晓纯何 宁
(首都医科大学大兴教学医院呼吸与危重症医学科,北京 102600)
Author(s):
LIU XuejiaoTAN XiaochunHE Ning
(Department of Respiratory and Critical Care Medicine,Daxing Teaching Hospital,Capital Medical University,Beijing 102600,China)
关键词:
重症肺炎支气管镜肺泡灌洗术病原菌
Keywords:
severe pneumoniabronchoscopy alveolar lavagepathogenic bacteria
分类号:
R563.7
DOI:
10.7683/xxyxyxb.2022.09.008
文献标志码:
A
摘要:
目的 探讨老年重症肺炎患者病原菌分布特征及支气管镜肺泡灌洗术的治疗效果与安全性。方法 选择首都医科大学大兴教学医院2016年1月至2020年1月收治的老年重症肺炎患者120例为研究对象并随机分为对照组(n=60)和观察组(n=60)。2组患者均给予常规治疗,观察组患者在常规治疗基础上给予支气管镜肺泡灌洗术治疗。对支气管肺泡灌洗液进行细菌培养,分析病原菌分布特征。分别于治疗前后抽取2组患者空腹外周静脉血4 mL,采用酶联免疫吸附法检测血清中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,采用超敏乳胶增强免疫比浊法检测血清中超敏C反应蛋白(hs-CRP)水平。 比较2组患者的临床疗效和治疗期间不良反应发生率。结果 观察组患者的支气管肺泡灌洗液中共分离出病原菌238株,其中革兰阴性杆菌147株(61.76%),以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、阴沟肠杆菌为主;革兰阳性杆菌54株(22.69%),以表皮葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌为主;真菌37株(15.55%),以白色念珠菌、近平滑念珠菌及烟曲霉菌为主。治疗前2组患者血清中IL-6、TNF-α、hs-CRP水平比较差异无统计学意义(P>0.05)。2组患者治疗后血清中IL-6、TNF-α、hs-CRP水平均低于治疗前(P<0.05)。治疗后,观察组患者血清中IL-6、TNF-α、hs-CRP水平显著低于对照组(P<0.05)。对照组和观察组患者治疗有效率分别为81.67%(49/60)、93.11%(55/60),观察组患者治疗有效率显著高于对照组(χ2=5.175,P<0.05)。对照组和观察组患者总不良反应发生率分别为6.67%(4/60)、3.33%(2/60),2组患者总不良反应发生率比较差异无统计学意义(P>0.05)。结论 支气管镜肺泡灌洗术可用于治疗老年重症肺炎,使用抗生素前分析肺泡灌洗液病原菌分布有助于指导医生用药,支气管镜肺泡灌洗术可减轻患者的炎症反应,安全性较高,疗效显著。
Abstract:
Objective To investigate the distribution characteristic of pathogenic bacteria in elderly patients with severe pneumonia and the therapeutic effect and safety of bronchoscopy alveolar lavage.Methods A total of 120 elderly patients with severe pneumonia admitted to the Daxing Teaching Hospital of Capital Medical University from January 2016 to January 2020 were selected as the research objects and they were randomly divided into control group (n=60) and observation group (n=60).All patients were given conventional therapy;based on conventional therapy,the patients in the observation group were treated with bronchoscopy alveolar lavage.The bronchoalveolar lavage fluid was cultured,and the pathogen distribution characteristics were analyzed.Before and after treatment,4 mL of fasting peripheral venous blood were taken from the patients in the two groups,and the levels of interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) in serum were detected by enzyme-linked immunosorbent assay,the level of high-sensitivity C-reactive protein (hs-CRP) in serum was detected by hypersensitive latex enhanced immunoturbidimetry.The clinical efficacy and the incidence of adverse reactions during treatment were compared between the two groups.Results A total of 238 pathogenic bacteria were isolated from the patients in the observation group,including 147 strains (61.76%) of gram-negative bacilli,mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli and Enterobacter cloacae;54 strains (22.69%) of gram-positive bacilli,mainly Staphylococcus epidermidis,Staphylococcus hemolyticus,and Staphylococcus aureus;37 strains (15.55%) of fungi,mainly Candida albicans,Candida parapsilosis and Aspergillus fumigatus.There was no significant difference in the levels of serum IL-6,TNF-α and hs-CRP of patients in the two groups before treatment(P>0.05).The levels of serum IL-6,TNF-α and hs-CRP of patients after treatment were significantly lower than those before treatment in the two groups (P<0.05).After treatment,the levels of serum IL-6,TNF-α and hs-CRP of patients in the observation group were significantly lower than those in the control group (P<0.05).The effective rates of patients in the control group and the observation group were 81.67% (49/60) and 93.11% (55/60),respectively;the effective rate of patients in the observation group was significantly higher than that in the control group (χ2=5.175,P<0.05).The total incidence of adverse reactions of patients in the control group and the observation group were 6.67% (4/60) and 3.33% (2/60),respectively;there was no significant difference in the total incidence of adverse reactions of patients between the two groups (P>0.05).Conclusion Bronchoscopy alveolar lavage can be used for the treatment of severe pneumonia in the elderly.Analysis of the distribution of pathogens in the alveolar lavage fluid before antibiotics is helpful to guide doctors to medication.Bronchoscopy alveolar lavage can reduce the inflammatory response of patients,it is safety and its curative effect is remarkable.

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更新日期/Last Update: 2022-09-05