纤维支气管镜肺泡灌洗诊疗术联合振动排痰对呼吸机相关性肺炎患者的影响

Impact of Fibrobronchoscopic Alveolar Lavage Combined with Vibratory Sputum Discarding on Patients with Ventilator-associated Pneumonia

目的探讨纤维支气管镜肺泡灌洗诊疗术联合振动排痰对呼吸机相关性肺炎(VAP)患者的影响。方法选取2018年3月—2019年3月西安医学院第一附属医院ICU收治的VAP患者88例,采用随机数字表法分为对照组和观察组,每组44例。在常规治疗基础上,对照组患者给予纤维支气管镜肺泡灌洗诊疗术治疗,观察组患者在对照组治疗基础上给予振动排痰治疗;两组患者均持续治疗1周。比较两组患者临床疗效、机械通气时间、抗菌药物应用时间、ICU入住时间,治疗前后呼吸功能指标[包括气道峰值吸气压力(PIP)、气道阻力(RAW)、呼吸做功(WOB)、动态肺顺应性(CLdyn)]、动脉血气分析指标[包括动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、氧合指数(OI)、动脉血二氧化碳分压(PaCO2)],并观察两组患者治疗期间不良反应发生情况。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)与对照组比较,观察组患者机械通气时间、抗菌药物应用时间、ICU入住时间缩短(P<0.05)。(3)观察组患者治疗前PIP、RAW、WOB、CLdyn与对照组相似,差异无统计学意义(P>0.05);与对照组比较,观察组患者治疗后PIP、RAW、WOB降低,CLdyn升高(P<0.05)。(4)观察组患者治疗前PaO2、SaO2、OI、PaCO2与对照组相似,差异无统计学意义(P>0.05);与对照组比较,观察组患者治疗后PaO2、SaO2、OI升高,PaCO2降低(P<0.05)。(5)治疗期间两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论纤维支气管镜肺泡灌洗诊疗术联合振动排痰治疗VAP患者的临床疗效确切,能有效缩短患者机械通气时间、抗菌药物应用时间及ICU入住时间,改善患者呼吸功能及缺氧状态,且安全性较高。

Objective To investigate the impact of fibrobronchoscopic alveolar lavage combined with vibratory sputum discarding on patients with ventilator-associated pneumonia(VAP). Methods From March 2018 to March 2019,a total of 88 patients with VAP were selected in ICU,the First Affiliated Hospital of Xi’an Medical University,and they were divided into control group and observation group according to random number table method,with 44 cases in each group. Based on conventional treatment,patients in control group received fibrobronchoscopic alveolar lavage,while patients in observation group received vibratory sputum discarding based on that of control group;both groups continuously treated for 1 week. Clinical effect,duration of mechanical ventilation and using antibiotics,ICU stays,as well as index of respiratory function(including PIP,RAW,WOB and CLdyn)and arterial blood-gas analysis results(including PaO2,SaO2,OI and PaCO2)before and after treatment were compared between the two groups,moreover incidence of adverse reactions was observed during treatment between the two groups. Results (1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)Compared with those in control group,observation group showed statistically significantly shorter duration of mechanical ventilation and using antibiotics,and ICU stays(P<0.05).(3)Compared with those in control group,observation group showed similar PIP,RAW,WOB and CLdyn before treatment(P>0.05),while statistically significantly lower PIP,RAW and WOB,but higher CLdyn after treatment(P<0.05).(4)Compared with those in control group,while observation group showed similar PaO2,SaO2,OI and PaCO2 before treatment(P>0.05),while statistically significantly higher PaO2,SaO2 and OI,but lower PaCO2 after treatment(P<0.05).(5)No statistically significant difference of incidence of adverse reactions was found between the two groups during treatment(P>0.05). Conclusion Fibrobronchoscopic alveolar lavage combined with vibratory sputum discarding has certain clinical effect and relatively high safety in treating patients with VAP,which can effectively shorten the duration of mechanical ventilation and using antibiotics as well as ICU stays,improve the respiratory function and relieve the anoxia.