胸部CT定位后纤维支气管镜气道灌洗在机械通气并发重症肺炎患者中的应用效果

Clinical value of bronchoalveolar lavage in patients with severe lung infection treated with mechanical ventilation CT device guidance

目的探讨CT定位下采用纤维支气管镜气道灌洗对机械通气并发重症肺炎的临床疗效。方法选择2012年3月-2014年9月于该院治疗的机械通气合并重症肺部感染者86例为研究对象。将患者随机分为对照组和观察组,每组43例,对照组患者在支气管镜灌洗前未做肺部影像学检查,观察组患者在气道灌洗前给与CT检查。监测患者呼吸频率、心率及血压等生命体征,灌洗前和灌洗后1 h的呼吸力学指标,并评价两组患者的临床疗效。结果观察组患者灌洗中及灌洗后10 min的呼吸频率及心率均明显低于对照组(P<0.05),血压差异无统计学意义(P>0.05)。观察组患者灌洗后1 h气道峰压(PIP)、吸气阻力(RAW)及呼吸功(WOBvent)均低于对照组(P<0.05),肺动态顺应性(Cdyn)明显高于对照组(P<0.05)。观察组患者治疗总有效率为97.67%;明显高于对照组患者治疗效有效率86.05%,差异有统计学意义(P<0.05)。结论采用胸部CT定位下纤维支气管镜气道灌洗,能够有效降低患者的应激反应、减轻气道高反应性,缩短机械通气及抗生素使用时间,提高临床疗效。

Objective To explore the effects of fiberoptic bronchoscopy for bronchoalveolar lavage（BAL） under chest computed tomography（CT） guidance and mechanical ventilation in the patients with severe pulmonary infection. Methods 86 severe pulmonary infection patients treated with mechanical ventilation, from March 2012 to September 2014 in our hospital, were selected for the study. The patients were randomly divided into control group and observation group, 43 cases in each group. Patients in control group were treated without radiological examination before bronchoscopy lavage, the observation group were given chest CT examination. Respiratory rate, heart rate and blood pressure and other vital signs were monitored. Vital signs and variables of respiratory mechanics of patients were monitored before and 1 h after BAL. The clinical efficacy of the two groups was compared. Results During BAL and at 10 min after BAL, respiratory rate and heart rate of observation group were lower than those of control group（P〈0.05）, there was no significant difference in blood pressure between groups One hour after BAL, peak inspiratory pressure（PIP）, airway resistance（RAW） and work of breathing ventilation（WOB vent） in observation group were lower than those in control group, therefore, dynamic compliance（Cdyn） in observation group was better than that in control group（P〈0.05）. The total effective rate of observation group was 97.67 %; and was significant higher than control group（86.05 %）, the difference was statistically significant（P〈0.05）. Conclusion BAL by using fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation, decrease airway hyper-reactivity, shorten the time of mechanical ventilation and antibiotics and improve the total effective rate.