[1]吴雪花,王昌锋,杨亚东.纤维支气管镜支气管肺泡灌洗治疗机械通气并发肺部感染疗效观察[J].新乡医学院学报,2017,34(7):596-598.[doi:10.7683/xxyxyxb.2017.07.011]
 WU Xue-hua,WANG Chang-feng,YANG Ya-dong.Effect of bronchofibroscope bronchoalveolar lavage in the treatment of pulmonary infection induced by mechanical ventilation[J].Journal of Xinxiang Medical University,2017,34(7):596-598.[doi:10.7683/xxyxyxb.2017.07.011]
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纤维支气管镜支气管肺泡灌洗治疗机械通气并发肺部感染疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年7
页码:
596-598
栏目:
临床研究
出版日期:
2017-07-05

文章信息/Info

Title:
Effect of bronchofibroscope bronchoalveolar lavage in the treatment of pulmonary infection induced by mechanical ventilation
作者:
吴雪花1王昌锋2杨亚东1
(1.黄冈市中心医院重症医学科,湖北 黄冈 438000;2.黄冈市中心医院呼吸内科,湖北 黄冈 438000)
Author(s):
WU Xue-hua1WANG Chang-feng2YANG Ya-dong1
(1.Department of Intensive Care Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei Province,China;2.Department of Respiratory Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei Province,China)
关键词:
机械通气肺部感染纤维支气管镜支气管肺泡灌洗肺功能降钙素原
Keywords:
mechanical ventilationpulmonary infectionbronchofibroscopebronchoalveolar lavagepulmonary functionprocalcitonin
分类号:
R563
DOI:
10.7683/xxyxyxb.2017.07.011
文献标志码:
A
摘要:
目的 探讨纤维支气管镜支气管肺泡灌洗治疗机械通气并发肺部感染患者的临床效果。方法 选取2015年6月至2016年6月黄冈市中心医院收治的机械通气并发肺部感染患者120例,根据治疗方法将患者分为观察组和对照组,每组60例。对照组患者给予常规治疗,观察组患者在常规治疗基础上给予纤维支气管镜支气管肺泡灌洗。对2组患者治疗前后动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)及血清C反应蛋白(CRP)、降钙素原(PCT)水平进行比较,并对2组患者疗效、机械通气时间、抗生素使用时间、症状改善时间、住院时间进行比较。结果 治疗前2组患者PaO2、PaCO2、SaO2及血清CRP、PCT水平比较差异均无统计学意义(P>0.05);治疗7 d后,2组患者PaO2、SaO2显著升高(P<0.05),PaCO2及血清CRP、PCT水平显著降低(P<0.05);且观察组患者PaO2、SaO2显著高于对照组(P<0.05),PaCO2及血清CRP、PCT水平显著低于对照组(P<0.05)。观察组患者机械通气时间、抗生素使用时间、呼吸衰竭纠正时间、咳嗽咳痰消失时间、肺部炎症吸收时间及住院时间均显著短于对照组(P<0.05)。观察组和对照组患者治疗总有效率分别为93.33%(56/60)、78.33%(47/60),观察组患者治疗总有效率显著高于对照组(χ2=5.551 1,P<0.05)。结论 纤维支气管镜支气管肺泡灌洗可显著改善机械通气并发肺部感染患者的临床症状和肺功能,减轻炎症反应,缩短治疗时间和住院时间。
Abstract:
Objective To investigate the clinical effect of bronchoalveolar lavage in the treatment of pulmonary infection induced by mechanical ventilation.Methods A total of 120 patients with pulmonary infection induced by mechanical ventilation were selected from June 2015 to June 2016 in Huanggang Central Hospital.The patients were divided into observation group and control group according to the treatment methods,60 cases in each group.The patients in the control group were treated with conventional treatment measures,and the patients in the observation group were treated with bronchoalveolar lavage by bronchofibroscope on the basis of routine treatment.The arterial oxygen partial pressure (PaO2),arterial carbon dioxide partial pressure (PaCO2),arterial oxygen saturation (SaO2) and the levels of serum C reactive protein (CRP),procalcitonin (PCT) were compared between the two groups before and after treatment.The curative effect,mechanical ventilation time,antibiotic use time,symptom improvement time and hospitalization time were compared between the two groups.Results There was no significant difference in the PaO2,PaCO2,SaO2 and the levels of serum CRP,PCT between the two groups before treatment(P<0.05).After treatment for seven days,the PaO2 and SaO2 increased significantly (P<0.05);the PaCO2 and serum CRP,PCT levels decreased significantly in the two groups(P<0.05);the PaO2 and SaO2 in the observation group were significantly higher than those in the control group (P<0.05);and the levels of PaCO2,serum CRP and PCT were significantly lower than those in the control group (P<0.05).The mechanical ventilation time,antibiotics use time,respiratory failure correction time,cough and expectoration disappearance time,lung inflammation absorption time and hospitalization time in the observation group were significantly shorter than those in the control group (P<0.05).The total effective rate in the observation group and control group was 93.33% (56/60) and 78.33% (47/60) respectively,the total effective rate in the observation group was significantly higher than that in the control group (χ2=5.551 1,P<0.05).Conclusion Bronchoalveolar lavage by bronchofibroscope can significantly improve the clinical symptoms and pulmonary function,reduce inflammation,shorten treatment time and hospitalization time in patients with pulmonary infection induced by mechanical ventilation.

参考文献/References:

[1] 牟丹辉,余方宇.机械通气患者肺部感染影响因素调查分析[J].实用预防医学,2014,21(6):729-731.
[2] 沈彩芳,占利.ICU患者肺部感染危险因素分析[J].中华医院感染学杂志,2014,24(7):1673-1674,1680.
[3] 张辉,张小燕,何彩霞,等.经纤支镜肺泡灌洗治疗机械通气下重症肺部感染的疗效观察[J].中国现代医生,2014,52(1):140-142.
[4] 牛汝辑.呼吸疾病诊疗指南[M].北京:科学出版社,1999:405-413.
[5] 丁硕,渠时学,李梅,等.不同途径纤维支气管镜肺泡灌洗在机械通气患者中的比较研究[J].浙江临床医学,2015,17(8):1302-1303.
[6] 赵勇.纤维支气管镜在ICU机械通气患者中的应用[J].四川医学,2013,34(7):967-969.
[7] 王中英.纤维支气管镜肺灌洗对ICU机械通气合并肺部感染老年患者降钙素原和细胞因子的影响[J].中国老年学杂志,2015,35(20):5894-5896.
[8] 钱平.机械通气患者发生呼吸机相关性肺炎危险因素分析[J].山东医药,2014,54(24):34-35.
[9] BAID H.Patient safety:identifying and managing complications of mechanical ventilation[J].Crit Care Nurs Clin North Am,2016,28(4):451-462.
[10] MARTYNOVA M A,KONOVALOV N A,LUBNIN A Y,et al.Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord:a case report and literature review[J].Zh Vopr Neirokhir Im NN Burdenko,2016,80(6):74-81.
[11] SHAHABI M,YOUSEFI H,YAZDANNIK A R,et al.The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation[J].Iran J Nurs Midwifery Res,2016,21(5):541-546.
[12] 刘兰,张静,贾玉花,等.γ-干扰素、白细胞介素17、白细胞介素13在毛细支气管炎患儿支气管肺泡灌洗液中变化的意义[J].中华实用儿科临床杂志,2015,30(4):314-315.
[13] 李明霞,范春红.纤支镜肺泡灌洗在COPD机械通气患者中的临床应用[J].临床肺科杂志,2013,18(3):518-519.
[14] 柏文祥.纤支镜肺泡灌洗对机械通气下肺部感染的治疗效果[J].临床肺科杂志,2016,21(2):361-362,371.
[15] 陈灿.老年重症肺部感染患者血清降钙素原表达水平及对机械通气撤机结局的预测价值[J].实用临床医药杂志,2016,20(11):28-31.
[16] 黄志雄.纤支镜肺泡灌洗治疗机械通气下重症肺部感染临床观察[J].中国现代药物应用,2015,9(5):166-167.

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更新日期/Last Update: 2017-07-05