支气管镜肺段灌洗联合丙种球蛋白治疗多药耐药菌肺炎的疗效研究

Study on the efficacy of lung lavage by bronchoscope combined with gamma globulin in the treatment of multi-drug resistant pneumonia

目的观察经支气管镜肺段灌洗联合丙种球蛋白治疗多药耐药菌肺炎的临床疗效,以提高肺炎的治愈率。方法选择78例多药耐药克雷伯菌属所致的肺炎患者作为研究对象,将所有患者随机分为两组,试验组41例、对照组37例,对照组患者选择合适抗菌药物进行常规治疗;观察组患者在对照组的基础上加用支气管镜肺段灌洗,同时联用丙种球蛋白治疗,观察两组患者治疗前后的血气分析相关指标及治疗后疗效。结果显效率试验组为43.9%,明显优于对照组13.5%,总有效率试验组90.2%,也明显优于对照组70.3%,差异有统计学意义(P<0.05);试验组患者治疗后动脉血氧分压、动脉血二氧化碳分压、动脉血氧饱和度与对照组相比,差异均有统计学意义(P<0.05);治疗前两组患者肺功能指标比较差异无统计学意义,治疗后试验组用力肺活量、一秒用力呼气容积、一秒率等各项指标与对照组比较,差异均有统计学意义(P<0.05)。结论支气管镜肺段灌洗联合丙种球蛋白是一种有效的重症肺部感染性疾病治疗方法,临床疗效显著、安全,对多药耐药菌肺炎具有良好的临床应用价值。

OBJECTIVE To observe the efficacy of lung lavage by bronchoscope combined with gamma globulin in the treatment of multi‐drug resistant pneumonia so as to improve the curative rate of pneumonia .METHODS Total‐ly 78 cases of patients with multidrug‐resistant pneumoniae caused by K lebsiella were chosen as research objects , and all the patients were randomly divided into two groups：41 cases in the experiment group and 37 cases in the control group .Skin test was conducted to the control group to choose the suitable antibiotics for routine therapy . On the basis of this ,the observation group used lung lavage by bronchoscope combined with gamma globulin .The related indexes of Qi and blood analysis and curative effect were observed in the two groups before and after the treatments .RESULTS The effectual rate in the experimental group was 43 .9% ,significantly higher than the con‐trol group of 13 .5% .And the total effective rate in the experiment group was 90 .2% ,also significently higher than the control group of 70 .3% （P〈0 .05） .After the treatments ,significant differences existed in arterial par‐tial pressure of oxygen ,carbon dioxide and arterial oxygen saturation between the two groups （P〈0 .05） .No sig‐nificant differences were found between the two groups by lung functions .But after treatments ,significant differ‐ences existed in indexes like forced vital capacity ,forced expiratory volume in one second and respiratory rate in a second between the two groups （P〈0 .05） .CONCLUSION Lung lavage by bronchoscope combined with gamma globulin is an effective method for curing severe pulmonary diseases with remarkable clinical efficacy and safety , hence is of high clinical value in treating multi‐drug resistant pneumonia .