床旁纤维支气管镜治疗呼吸机相关性肺炎的临床研究

Clinical research on fiberoptic bronchoscopy applied in treatment of ventilator-associated pneumonia

目的探讨床旁纤维支气管镜治疗呼吸机相关性肺炎的临床价值。方法将2008年1月-2010年12月入住重症监护病房且资料完整的患者随机分组,在常规抗感染治疗基础上,治疗组行每日常规吸痰管吸痰+纤维支气管镜吸痰或灌洗,对照组每日常规吸痰管吸痰,用临床肺部感染评分进行VAP评估。结果共有69例患者入选,机械通气>48h,VAP诊断明确,治疗组35例,对照组34例,2组患者的一般资料差异无统计学意义,两组患者平均APACHEⅡ评分为(20.05±3.81)分,CPIS评分平均值为(6.9±1.8)分;在发生VAP的第3、5、7天,两组CPIS评分之间的差异均有统计学意义(均P<0.05);治疗组在纤维支气管镜治疗前后比较,CPIS评分显著降低(P<0.05);两组比较,在发生VAP后治愈所需时间、住ICU天数、机械通气时间之间的差异均有统计学意义(均P<0.05)。结论临床肺部感染评分监测对预测VAP患者的预后具有指导意义;床旁纤维支气管镜治疗可缩短VAP患者机械通气时间及ICU住院天数。

OBJECTIVE To evaluate the clinical significance of fiberoptic bronchoscopy for patients with the ventilator-associated pneumonia（VAP）.METHODS The patients enrolled in ICU from Jan.2008 to Dec.2010 with the complete data were randomly divided into the treatment group and the control group.The treatment group received fiberoptic bronchoscopy plus daily conventional suction on the basis of anti-infection treatment,while the control group received daily conventional suction.VAP was evaluated by clinical pulmonary infection score.RESULTS A total of 69 patients were involved in the study,mechanical ventilation 48 h,with definite diagnosis of VAP.Thirty-five cases were included in treatment group and 34 cases in control group.There was no difference in the clinical data between the 2 groups.The average score of APACHEⅡ was（20.05±3.81）,the average of CPIS was（6.9±1.8） of the 69 patients.After the diagnosis of VAP on 3rd,5th and 7th day,the difference in CPIS score between two groups was statistically significant（P〈0.05）;CPIS score decreased significantly after patients received fiberoptic bronchoscopy（P〈0.05）.There were statistical differences in the time of cure for VAP,the time of mechanical ventilation and the time of ICU stay（P〈0.05）.CONCLUSION Serial monitoring of CPIS is valuable in evaluating the prognosis of the patients with the ventilator-associated pneumonia.Fiberoptic bronchoscopy can significantly reduce the time of mechanical ventilation and hospitalization in ICU.