肺泡灌洗联合抗感染治疗呼吸机相关肺炎的研究

The clinical study of fiber bronchoscope alveolar lavage combined with anti-infection in treating severe ventilator-associated pneumonia

目的研究纤维支气管镜肺泡灌洗联合抗感染治疗重症呼吸机相关性肺炎(VAP)的临床疗效。方法随机双盲法将符合纳入标准的68例重症呼吸机相关性肺炎患者分为两组,每组34例,对照组采取抗感染联合常规灌洗吸痰治疗,观察组则行纤维支气管镜肺泡灌洗联合抗感染治疗,比较两组临床疗效、治疗前后呼吸力学参数、CPIS评分及机械通气时间等相关指标。结果观察组总有效率94.1%,显著高于对照组的76.5%(P<0.05);观察组灌洗后1 h、4 h气道峰压(PIP)、呼吸功(WOB)、气道阻力(AWR)、动态顺应性(Cdyn)水平明显优于对照组(P<0.05);两组机械通气时间[(9.7±5.3)VS(12.6±6.2)]d、ICU入住时间[(11.6±6.0)VS(14.9±7.4)]d、治疗第7d CPIS评分[(14.0±2.5)VS(17.2±2.6)]分比较差异均有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗联合抗感染治疗重症VAP疗效明确,能明显改善患者呼吸力学参数及肺部感染症状,缩短机械通气时间,值得临床推广。

Objective To study the clinical effect of fiber bronchoscope alveolar lavage combined with anti-infection in treating severe ventilator-associated pneumonia（VAP）. Methods 68 cases of patients with severe ventilator associated pneumonia and meeting the criteria of admission were divided into two groups by randomized double-blind method with34 cases in each group. The control group was treated with anti-infection combined with conventional lavage and sputum suction while the observation group was given fiber bronchoscope alveolar lavage combined with anti-infection. The indexes such as clinical curative effect, respiratory mechanical parameters before and after the treatment, CPIS score and duration of mechanical ventilation were compared between the two groups. Results In the observation group, the total effective rate was 94.1% which was significantly higher than 76.5% of the control group（P〈0.05）; in the observation group, the levels of PIP, WOB, Raw, and Cdyn 1 h after lavage, 4H were significantly better than those in the control group（P〈0.05）; the differences in time of mechanical ventilation [（9.7 ±5.3） vs（12.6 ±6.2） ]d, ICU stay [（11.6 ±6.0） vs（14.9±7.4） ]d, the 7th day of treatment CPIS score [（14.0±2.5） vs（17.2±2.6） ] between the two groups were statistically significant（P〈0.05）. Conclusion The curative effect of fiber bronchoscope alveolar lavage combined with anti-infection in treating severe VAP was definite,which can significantly improve the respiratory mechanical parameters and symptoms of pulmonary infection, shorten the duration of mechanical ventilation and it is worth clinical promotion.