经纤支镜灌洗治疗机械通气肺部感染患者的临床观察

The Clinical Study on Bronchofibroscope Lavage Treatment to Mechanical Ventilation Related Pulmonary Infection

目的:观察机械通气下对严重肺部感染的危重症患者采用床旁经纤维支气管镜灌洗治疗效果。方法:对合并严重肺部感染出现I型或Ⅱ型呼吸衰竭而行有创机械通气的各种危重症患者28例,均在全身应用抗菌药物、祛痰药的基础上, 在实时心电、血压、血氧饱和度、呼吸监测下进行床旁经纤支镜灌洗治疗。比较治疗前后患者体温、痰量及性质、肺部湿啰 音、肺不张者肺段呼吸音情况、血氧饱和度、血气分析的变化及胸部X线表现变化以评价疗效。结果:全部28例患者住 ICU 2-63 d,平均24．5 d,住ICU期间经纤支镜灌洗1-6次,平均2．4次。纤支镜灌洗治疗后较治疗前SaO2(93±5％和 86±4％。P<0．05)、PaO2(87±8mmHg和68±10 mmHg,P<0．05)明显提高,PaO2明显下降(37±7 mmHg和48±9 mmHg,P<0．05);25例(89．3％)经纤支镜灌洗治疗后肺内感染得到控制;4例肺不张患者经纤支镜灌洗治疗后肺完全复张;3例患者因原发病进行性加重体温、痰量及性质、肺部听诊及胸部X线表现无变化。无气胸及严重的气道内出血等并发症发生。结论:重症监护病房中在机械通气下对严重肺部感染的危重症患者采用纤支镜灌洗治疗可促进肺部感染的控制。

Objetive： To observe the therapeutic effect of bronchofibroscope lavage for serious pulmonary infection caused by mechanical ventilation. Methods：All of 28 severe patients of pulmonary infection were performing mechanical ventilation because of Ⅰ-type orⅡ-type respiratory failure They all accepted the treatment of broncbofibroscope lavage under the monitoring of ECG, blood pressure and blood oxygen saturation. Mean while, the antibiotics and apophlegmatic drug were used too. The index we used to evaluate the therapeutic effect include the change of body temperature, quantity and quality of sputum, bellows auscultation, breath sound changing of pulmonary atelectasis, saturation of blood oxygen, blood gas analysis and chest x- ray. Results： The staying days in ICU of all 28 cases were 2-63d, the mean was 24. 5d, 1-6 bronchofibroscope lavage treatments were performed, the mean was 2.4. Compared to prior treatment ,the SaO2 （93 ± 5% vs 86 ± 4%, P〈0. 05）and PaO2 （87 ± 8 mmHg vs 68 ±10 mmHg,P〈0. 05）increased , PaCO2 （37 ± 7 mmHg vs 48 ± 9 mmHg,P〈0. 05）decreased significantly. After bronchofibroscope lavage treatment, 25 patients with pulmonary infection were controlled, all 4 cases with pulmonary atelectasis were completely recovered. But the body temperature, quantity and quality of sputum, bellows auscultation and chest X-ray of 3 patients did not improve obviously because of their primary disease aggravation. No complications such as aeropleura and respiratory tract bleeding occurred. Conclsiion： Bronchofibroscope lavage treatment can be an effective way to control severe pulmonary infection caused by mechanical ventilation in intensive care unite.