连续性血液净化联合支气管肺泡灌洗救治重症肺炎机械通气患者的临床研究

The clinical research of continuous blood purification combined with bronchoalveolar lavage treatment on severe pneumonia patients with mechanical ventilation

目的评价连续性血液净化(CBP)联合支气管肺泡灌洗治疗重症肺炎并机械通气患者的疗效,探讨促炎因子TNF-α、IL-6和抑炎因子IL-10的临床意义及其预后的关系。方法 22例重症肺炎机械通气患者采用CBP联合肺泡灌洗,用放免法检测重症肺炎机械通气组和无感染患者组(对照组)血清和支气管肺泡液(BALF)中TNF-α、IL-6和IL-10水平,并检测血气分析。结果重症肺炎机械通气患者治疗前、治疗后24h血清及BALF中的TNF-α、IL-6均明显高于对照组(P<0.01),治疗前BALF中的TNF-α、IL-6明显高于血清中水平(P<0.05);血清及BALF中治疗前TNF-α、IL-6明显高于治疗后24 h(P<0.01);治疗前BALF和血清中的IL-10无统计学差异(P>0.05),均明显低于对照组(P<0.05),治疗后24 h BALF和血清中的IL-10均明显高于对照组(P<0.01),而BALF中IL-10明显高于血清(P<0.01);治疗后24 h PaO2和氧合指数(PaO2/FiO2)明显高于治疗前(P<0.01),PaCO2明显低于治疗前(P<0.05)。结论 CBP联合支气管肺泡灌洗治疗重症肺炎并机械通气,可降低炎性介质对肺损伤,降低并发症的发生,促进重症肺炎机械通气患者早日脱离机械通气,有较高临床价值。

Objective To evaluate the efficacy of continuous blood purification（CBP） combined with bronchoalveolar lavage on treatment of severe pneumonia patients with mechanical ventilation,and to explore the clinical value of determination of pro-inflammatory cytokines TNF-α,IL-6 and anti-inflammation factor IL-10 and the relationship between them and prognosis.Methods 22 cases of severe pneumonia patients with mechanical ventilation were treated with CBP and bronchoalveolar lavage.The levels of TNF-α,IL-6 and L-10 were detected with RIA on severe pneumonia patients with mechanical ventilation（experimental group） and non-infected patients（control group） in serum and bronchoalveolar lavage fluid（BALF）,and arterial blood was analysis.Results The concentration level of TNF-α and IL-6 in experimental group before and 24h after treatment were significantly higher than those in control group（P0.05）,but all these were significantly lower than those in control group（P〈0.05）.24h after treatment,IL-10 in serum and BALF were significantly higher than that in control group（P〈0.01）,and in BALF were significantly higher than in serum（P〈0.01）.Both PaO2 and PaO2/FiO2 24h after treatment were significantly higher than those before treatment in experimental group（P〈0.01）,and PaCO2 was significantly lower than that before treatment（P〈0.05）.Conclusion CBP combined with bronchoalveolar lavage in treatment of severe pneumonia with mechanical ventilation can reduce inflammatory mediators injury lung,decrease the occurrence of complications,early off-line,and have a higher clinical value for severe pneumonia patients.