气管镜联合氨溴索治疗卒中相关性肺炎的临床研究

Clinical study of bronchoscope and ambroxol in the treatment of stroke associated pneumonia

目的探讨气管镜联合氨溴索治疗卒中相关性肺炎的临床效果。方法选择2010年6月—2015年6月收治的98例卒中相关性肺炎患者作为研究对象,随机分为对照组和观察组各49例。对照组给予抗感染、祛痰等常规治疗,观察组在对照组基础上加用气管镜与压缩雾化吸入氨溴索联合治疗。分析两组患者治疗前后急性生理学与慢性健康状况评分系统(acute physiology and chronic health evaluation,APACHEⅡ)、临床肺部感染评分(clinical pulmonary infection score,CPIS)、血清降钙素原、血TNF-α、肺泡灌洗液IL-6水平。计量资料采用t检验,P<0.05为差异有统计学意义。结果治疗后5 d,观察组APACHEⅡ评分、CPIS、血清降钙素原、TNF-α及肺泡灌洗液IL-6水平分别为(11.1±5.1)、(6.2±1.5)分、(2.0±0.2)pg/ml、(191.8±28.3)pg/L、(146.7±39.9)ng/L,均低于对照组的(17.5±5.2)、(8.5±1.7)分、(2.3±0.5)pg/ml、(220.6±55.2)pg/L、(242.6±50.8)ng/L,差异均有统计学意义(均P<0.05)。治疗后10 d,观察组APACHEⅡ评分、CPIS、血清降钙素原、TNF-a及肺泡灌洗液IL-6水平分别为(5.3±1.2)、(5.8±1.2)分、(0.9±0.1)pg/ml、(56.8±11.9)pg/L、(90.7±11.9)ng/L,均低于对照组的(10.4±5.3)、(7.9±2.5)分、(1.9±0.3)pg/ml、(109.3±15.3)pg/L、(130.2±19.4)ng/L,差异均有统计学意义(均P<0.05)。结论气管镜联合氨溴索雾化吸入治疗卒中相关性肺炎效果显著,值得临床推广应用。

Objective To investigate the clinical, effect of bronchoscope and ambroxol in the treatment of stroke associated pneu- monia.Methods 98 eases of stroke associated pneumonia patients from June 2010 to June 2015 were selected and randomly di- vided into control group and observation group（n=49）.The paiients in control group were treated with anti-infection and expecto- rant.Patients in the observation group were treated with bronehoscope and ambroxol by aerosol inhalation.The changes of acute physiology arid chronic health evaluation（APACHE Ⅱ ）,clinical pulmonary infection seore（CPIS）,serum procaleitonin,serum TNF-α, IL-6 in the lung lavage fluid were receded.Measurement data was processed by t test,P〈0.05 was considered statistically signifi- cant.Results After 5-day treatment,the level of APACHE Ⅱ ,CPIS,serum procaleitonin,serum TNF-α,IL-6 in the lung lavage fluid of the observation group were （11.1 ± 5.1）,（6.2 ± 1.5）points,（2.0 ± 0.2）ng/ml,（191.8 ± 28.3）pg/L,（146.7 ± 39.9）ng/L,whieh were lower than those of the control group [（17.5 ± 5.2）,（8.5 ± 1.7）points,（2.3 ± 0.5）pg/ml,（220.6 ± 55.2）pg/L,（242.6 ± 50.8）ng/L],the dif- ferences were statistically significant （all P〈0.05）.Afier 10-day treatment, the level of APACHE Ⅱ ,CPIS,serum procalcitonin,serum TNF-α,IL-6 in the lung lavage fluid of the observation group were （5.3 ± 1.2）,（5.8 ± 1.2）points,（0.9 ± 0.1）pg/ml,（56.8 ± 11.9）pg/L, （90.7 ± 11.9）ng/L,lower than those of the control group [（10.4 ± 5.3）,（7.9 ± 2.5）points,（1.9 ± 0.3）pg/ml,（109.3 ± 15.3）pg/L,（130.2 ± 19.4）ng/L],the differences were statistically significant （all P〈0.05）.Conclusion Bronchoseope combined with ambroxol by aerosol inhalation have obvious effect in the treatment of stroke associated pneumonia patients.It is worth to be prOmoted widely in clinical. practice.