纤维支气管镜在老年人坠积性肺炎治疗中的临床价值

Fiber bronehoscope in treatment of elderly patients with hypostatie pneumonia

目的探讨纤维支气管镜在老年人坠积性肺炎治疗中的临床价值。方法选取2012年5月至2014年5月在佛山市顺德区乐从医院呼吸内科住院的坠积性肺炎患者100例。根据治疗方案的不同将患者分为治疗组（n=50）和对照组（n=50）。治疗组在常规治疗的基础上，行纤维支气管镜吸痰、灌洗及局部注药，经防污染毛刷取样或收集灌洗液行细菌培养；对照组常规治疗，常规取痰行细菌培养；根据细菌培养及药敏结果调整两组患者抗生素的使用。观察指标：治疗效果、死亡率、细菌培养结果、纤维支气管镜治疗的不良反应、住院时间。结果治疗组总有效率为84％，死亡率为8％；对照组总有效率为64％，死亡率为28％；两组比较差异有统计学意义（P〈0．05）。治疗组细菌培养阳性率为88％，对照组为44％，差异有统计学意义（P〈0．05）。治疗组革兰氏阴性致病菌占82．0％，对照组革兰氏阴性致病菌占86．4％；治疗后，治疗组细菌培养阴转率为86．4％，对照组为45．5％；两组对比，差异有统计学意义（P〈0．05）。治疗组平均住院时间为（18．42±4．77）天，对照组为（23．06±6．08）天，差异有统计学意义（P〈0．05）。纤维支气管镜治疗中未发生严重不良反应。结论应用纤维支气管镜治疗老年人坠积性肺炎效果良好，可降低死亡率，提高致病菌检出率，缩短住院时间，降低住院费用，且是安全的，值得临床推广应用。

Objective To explore the clinical value of fiber bronchoscope in the treatment of elderly patients with hypostatic pneumonia. Methods 100 elderly patients with hypostatic pneumonia were selected from the Department of Respiratory Medicine at Lecong Hospital of Shunde, Foshan from May, 2012 to May, 2014. According to different treatment plans, the patients were divided into a treatment group（n=50）and a control group（n=50）. In addition of routine treatment, the treatment group accepted sputum aspiration and lavage with bronchofibroscope; the specimens were sampled via protected specimen brush （ PSB ） or lavage for bacterial culture. The control group received routine treatment; sputum specimens were sampled routinely for bacterial culture. Antibiotics were used and adjusted according to the results of the bacterial culture and the drug sensitive test was carried out in both groups. The therapeutic effect, mortality, results of bacterial culture, hospital stays, and adverse effects of the treatment with fiber bronehoscope were observed. Results The total effective rate and the mortality were 84% and 8% in the treatment group and were 64% and 28% in the control group, with statistical differences（P 〈 0.05）. 88% patients of the treatment group and 44% of the control group were positive in bacterial cuhure.82.0% patients of the treatment group and 86.4% of the matched group were positive in Gram negative pathogenic bacteria. After the treatment, the bacterial negative rate was 86.4% in the treatment group and was 45.5% in the control group, with a statistical difference（P 〈 0.05）. The mean time of hospital stay was （ 18.42 ± 4.77 ） days in the treatment group and was （23.06 ± 6.08 ） days in the control group, with a statistical difference（P 〈 0.05）. No severe adverse reactions occurred during the treatment with the fiber bronchoscope. Conclusions Fiber bronchoscope in the treatment of elderly patients with hypostatic pneumonia is effective and safe and can reduce the mortality, increase the detectable rate of pathogenic bacteria, shorten the hospital stay, and reduce the hospitalization expense. It is worth being clinically generalized.