支气管肺泡灌洗加注药在老年危重患者肺部感染中的疗效分析

Effect of bronchoalveolar lavage on pneumonia in critically ill elderly patients

目的探讨支气管肺泡灌洗(bronchoalveolar lavage,BAL)加注药在老年重症肺部感染患者中的治疗效果。方法 68例老年重症肺部感染且需机械通气的患者分为治疗组36例及对照组32例,2组均给予全身应用抗生素、营养支持、纠正水电解质平衡及脏器功能支持等治疗,对照组给予常规吸痰及体位引流排痰,治疗组在常规吸痰及排痰的基础上行纤支镜下BAL+注药,3～4d重复1次,比较2组患者的治疗有效率、28d病死率、继发器官功能不全及临床肺部感染评分(clinical pulmonary infection score,CPIS)改善情况。另比较治疗组患者每次灌洗前及灌洗后第1、2、3天氧合指数及CPIS等指标的变化。结果治疗组有效率(治愈+好转)为91.6%,明显高于对照组(68.7%),差异有统计学意义(P<0.05);治疗组28d病死率(13.9%)明显低于对照组(34.3%)(P<0.05);治疗1周后治疗组CPIS评分改善程度较对照组明显(P<0.01);治疗组平均继发脏器功能衰竭数(1.81±0.98)较对照组(2.66±1.21)明显降低(P<0.05)。治疗组BAL+注药后第1天氧合指数(268.88±91.24)较灌洗前(238.28±95.48)明显升高(P<0.01),灌洗后第3天CPIS评分(6.58±1.45)较灌洗前(7.25±1.31)明显下降(P<0.01)。结论在老年重症肺部感染患者中予BAL+注药治疗是安全、有效的,可在短期内改善患者的氧合及CPIS评分,同时可减少老年患者的继发器官功能衰竭。

Objective To observe the effect of bronchoalveolar lavage(BAL) on pneumonia in critically ill elderly patients.Methods Sixty-eight critically ill elderly patients with pneumonia receiving mechanical ventilation were divided into BAL group(36 cases) and control group(32 cases).In addition to the routine therapy of antibotics,nutritional support,acid-base balance and organ function support,the BAL group received bronchoalveolar lavage(twice a week),and the control group received sputum aspiration and postural drainage.The therapeutic effects,28-day mortality,secondary organ dysfunction and the improvement of clinical pulmonary infection score(CPIS) in the two groups were evaluated and compared.In the BAL group,oxygenation index and CPIS changes were observed before and after BAL.Results The percentage of improvement rate in the BAL group(91.6%) was significantly higher than that(68.7%) in the control group(P<0.05).The level of CPIS was improved significantly in the BAL group compared to the control group(P<0.01).28-day mortality and secondary organ dysfunction in BAL group was significantly lower than that in the control group(P<0.05 or P<0.01).In the BAL group,the oxygenation index after BAL was significantly increased(P<0.01),and CPIS after BAL was significantly decreased(P<0.01).Conclusions BAL may be an effective and safe method for treatment of severe pneumonia in the elderly.BAL may improve oxygenation and promote lesion absorption in the short term.At the same time,it may reduce secondary organ failure in the elderly patients.