经支气管镜气道管理在治疗肺部多重耐药菌感染的有效性分析

Treatment of the multi-drug resistance pulmonary infection

目的探讨肺部耐药菌感染的非抗菌药物治疗方案。方法对2010年住院时间长达4个月的1例肺部多重耐药菌感染合并呼吸衰竭、全身营养不良、肠道菌群失调和极度衰竭的老年患者,在抗感染治疗的同时,给予气管切开开放气道,机械通气,后期采取停用全部抗菌药物,单纯反复的支气管镜灌洗治疗以及营养支持治疗策略。观察患者症状、影像学变化以及支气管镜检查情况。结果在后期多次痰培养阳性的情况下,经过非抗菌药物综合治疗,患者咯痰量减少,营养状况改善,进食好转,胸部影像学病灶有吸收好转,最终好转出院。在丙泊酚静脉麻醉下行支气管镜检查共32次,检查过程中无明显异常情况出现。结论在肺部多重耐药菌感染的治疗方案中,支气管镜灌洗治疗和营养支持治疗非常重要。老年患者多次在丙泊酚静脉麻醉下行支气管镜检查安全有效。

Objective To discuss the non-drug treatment of the multi-drug resistance pulmonary infection. Methods 1 old female patient with multi-drug resistance pulmonary infection, who had complications such as respiratory failure, dystrophy,flora imbalance in the intestinal tract and cachexy, was selected. Her length of stay were more than 4 months in 2010. While with the treatment of antibacterial, she accepted tracheotomy, mechanical ventilation, bronchoscope lavage and nutritional support. To observe the change of the symptoms and chest CT. To note the process of the bronehoscope. Results The patient＇s sputum was reduced. Her nutrition was better. The focus on her chest CT was reduced. She got better and left hospital. She received bronchoscope for 32 times, and there weren＇t abnormal conditions through the ex- aminations. Conclusion The bronchoscope lavage and the nutritional support were very importable to the patients with multi-drug resistance pulmonary infection. The old patients accepted bronehoscope after propofol vein anesthesia were safe.