早期床旁纤维支气管镜吸痰及肺泡灌洗在卒中相关性肺炎患者中的应用

Application of early bedside fibrous bronchoscope suction and bronchoalveolar lavage in patients with stroke associated pneumonia

目的观察床旁纤维支气管镜吸痰及肺泡灌洗在卒中相关性肺炎患者中的应用价值及安全性。方法将139例卒中相关性肺炎患者随机分为常规组(69例)和纤维支气管镜治疗组(70例)。常规组采用普通吸痰管吸痰及抗生素等常规治疗;纤维支气管镜治疗组在常规治疗的同时采用纤维支气管镜吸痰及肺泡灌洗。动态观察患者体温、血常规、胸片及气管分泌物,用简化临床肺部感染评分(CPIS)对患者进行肺部感染评分。比较两组患者治疗前后临床肺部感染评分、使用抗生素时间,每天吸痰次数、住院天数,病死率及检查不良反应发生率。结果纤维支气管镜治疗组冶疗前后临床肺部感染评分(CPIS)比较、住院天数、使用抗生素时间、每天吸痰次数等指标均优于常规组(P﹤0.05)。纤维支气管镜检查不良反应少。结论在加强抗感染的基础上进行纤维支气管镜吸痰及肺泡灌洗是治疗卒中相关性肺炎的一种有效、安全的辅助治疗措施,具有很高的临床应用价值,值得推广应用。

Objective To observe the application value and safety of bedside fibrous bronchoscope suction and bronchoalveolar lavage in patients with stroke associated pneumonia（SAP）.Methods One hundred and thirty-nine patients with stroke associated pneumonia were randomly divided into two groups,control group（69 cases） and treatment group（70 cases）.All the patients were given the same regular treatment such as sputum sucking by common tube and antibiotic drugs.The patients in treatment group were treated with fibrous bronchoscope suction and alveolar lavage.The body temperature,blood routine examination,chest X-ray and trachea secretion were dynamicly observed.All the patients were scored by simplified clinic pulmonary infection score（CPIS）.The scores of CPIS,time of antibiotics therapy,frequencies of sputum suction,hospitalization days,mortality rate and adverse reaction rate in the two groups were compared.Results The score of CPIS,hospitalization days,time of antibiotics therapy,frequencies of sputum suction,mortality rate and adverse reaction rate in treatment group were superior to those in control group（P0.05）.Adverse reactions of fibrous bronchoscops suction were few.Conclusion On the basis of antibiotics therapy,fibrous bronchoscope suction combined with alvelar lavage is an safe and effective method for treatment of SAP.It has high clinical value,and is worth application in clinic.