纤维支气管镜吸痰和灌注后注药对胸外术后并发肺部感染的治疗作用

Curative effects of amikacin given after drawing spittoon by bronchofiberscopy and bronchoalveolar lavage in treating patients complicating pulmonary infection after thoracic operations

目的探讨纤维支气管镜(纤支镜)吸痰和灌洗后注药术对胸部外科手术后肺部感染的治疗作用。方法分析51例经积极常规治疗无效,肺部感染加重合并肺不张、呼吸衰竭的术后病人,在监护条件下行纤支镜吸痰和灌洗后注药,选用无菌生理盐水(37℃)作为灌洗液和稀释液,阿米卡星(丁胺卡那霉素)气管内给药,观测临床症状、体征和胸部X线改变。结果51例行纤支镜吸痰和灌洗后注药治疗,并指导抗生素应用,7d内显效44例,有效6例,无效1例,总有效率98%。吸取的分泌物培养出致病菌有38例,病菌分离率75%,但原病人咯出痰的痰培养只有8例阳性,病菌分离率15.8%。无严重并发症发生。结论胸外术后肺部感染病人使用纤支镜治疗,有助于确定致病菌,较彻底清除大气道分泌物,改善肺通气功能,局部给药提高病灶内药物浓度,增强抗菌效果,无不良反应。

[Objective] To probe curative effects of amikacin given after drawing spittoon by bronchofiberscopy and bronchoalveolar lavage in treating the patients complicating pulmonary infection after thoracic operations.[Methods] First, 51 patients were drawn spittoon by bronchofiberscopy. Then, the bronchoalveolar lavage was carried out with aseptic normal saline （37℃）. Last, amikacin and a little aseptic normal saline given by bronchofiberscopy. To observe the clinical symptoms, body signs and X-ray changes. [Results] The treatment cured 50 patients in a short time. [Conclusions] The treatment possesses the advantages that are to helpfully find pathogenic bacteria and clear away secretion in the tracheas, better local anti-inflammatory actions. Its curative effects are confirmed and there are not harmful reactions to be found.