经支气管镜肺段灌洗联合丙种球蛋白对多重耐药菌肺炎的疗效观察

Effects of Bronchoscope Pulmonary Segment Lavage in Combination with Intravenous Immunoglobulin in the Treatment of Multidrug Resistant Pneumonia

目的研究经支气管镜肺段灌洗联合病种球蛋白治疗多重耐药菌肺炎的疗效。方法选择50例经病理学检查确认为多重耐药菌肺炎患者为研究对象,采用临床肺部感染评分法,均符合医院获得性肺炎和呼吸机相关性肺炎的诊断标准。将50例患者随机分作联合组和对照组各25例,均实行抗感染治疗、营养支持,每日注射丙种球蛋白。联合组在上述基础上采用支气管镜肺段灌洗。观察项目:1临床指标:住院天数、肺部体征开始消退时间。2出院后每3个月进行随访。结果联合组在痰量,动脉血氧分压、呼吸频率、体温等方面均得到明显改善(P<0.05);疗效明显优于对照组(P<0.05),联合组平均住院日为(21.4±5.6)天,对照组为(28.6±7.3)天,P<0.05。联合组与对照组肺部体征开始消退天数分别为(7.31±1.57)天和(10.26±3.41)天,存在统计学差异(t=-2.415,P<0.05)。结论经支气管镜肺段灌洗联合丙种球蛋白治疗多重耐药菌肺炎疗效肯定,操作简便,使用安全,具有较高的临床应用价值。

Objective To study the effects of bronchoscope pulmonary segment lavage in combination with intravenous immunoglobulin in the treatment of multidrug resistant pneumonia.Methods A total of 50 patients with multidrug resistant pneumonia confirmed by pathological examination were selected as the subjects.Clinical Pulmonary Infection Score was adopted as the diagnostic criterion for hospital acquired pneumonia and ventilator associated pneumonia.The patients were randomized into the combination group and control group,both of which received conventional treatments such as anti-infection and nutritional support,as well as injection of intravenous immunoglobulin（IVIG）.On the basis above,the combination group also received bronchoscope pulmonary segment lavage.The content of observation was as follows： 1 clinical indicators： hospital stay,the time when pulmonary signs began to disappear; 2 follow-up observation： follow-up visits were performed every 3 months after discharge,the content of which included clinical manifestation and signs.Results Patients who received bronchoscope pulmonary segment lavage showed significantly decreased body temperature,significantly reduced sputum volume,and significantly improved respiratory rate,Pa O2 and chest X-ray（P〈0.05）; the combination group showed significantly better effects（P〈0.05）,and the average hospital stay of the combination group and control group was（21.4 ± 5.6） d and（28.6 ± 7.3） d respectively,showing significant difference（t =-2.164,P〈0.05）.The time when pulmonary signs began to disappear was（7.31 ± 1.57） d and（10.26 ±3.41） d respectively,showing significant difference（t =-2.415,P〈0.05）.Conclusions Bronchoscope in combination with IVIG has certain effects on multidrug resistant pneumonia,which is a safe and simple treatment with high clinical application value.