纤维支气管镜局部灌洗治疗对急性肺脓肿临床有效性及生活质量的影响

Clinical effects and influence of life quality of fiber bronchoscope local lavage in the treatment of acute lung abscess

目的探讨纤维支气管镜局部灌洗治疗对急性肺脓肿临床有效性及生活质量的影响。方法选取2012年9月—2013年6月本院呼吸内科收治的急性肺脓肿患者110例作为研究对象,随机分为对照组和研究组各55例。对照组采取常规内科综合治疗,包括敏感抗生素结合体位引流、湿化气道、祛痰、雾化治疗,对症治疗并发症及全身营养支持等。研究组在对照组的基础上加用经纤维支气管镜肺泡灌洗,局部给药。观察比较两组患者的住院时间,肺部啰音、脓腔、体温恢复、咳嗽咳痰等临床症状的缓解时间,评估临床疗效,观察治疗前后动脉血气指标变化情况。出院6个月随访时,利用SF-36健康调查表进行生活质量评价。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ^2检验,P〈0.05为差异有统计学意义。结果研究组总有效率为100.0%,明显高于对照组的61.8%,差异有统计学意义（P〈0.05）。研究组住院时间、肺部啰音消失时间、脓腔消失时间、体温恢复时间、咳嗽咳痰缓解时间分别为（16.1±2.4）、（11.8±1.6）、（13.9±1.5）、（6.1±0.4）、（10.9±0.9）d,均优于对照组的（22.3±2.9）、（17.9±2.8）、（19.6±2.8）、（9.1±0.6）、（14.8±2.3）d,差异均有统计学意义（均P〈0.05）。治疗后,研究组与对照组FEV1、FVC、Pa O2水平分别为（3.26±0.38）、（3.86±0.18）L、（80.9±7.3）mm Hg（1 mm Hg=0.133 k Pa）、（2.86±0.19）、（3.24±0.21）L、（70.9±2.3）mm Hg,均较治疗前的（2.19±0.27）、（2.41±0.29）L、（61.5±1.0）mm Hg、（2.12±0.34）、（2.39±0.36）L、（61.2±1.3）mm Hg改善明显,差异均有统计学意义（均P〈0.05）。出院后6个月,研究组的躯体功能、躯体角色、躯体疼痛、总体健康、精力、社会功能、情感职能、心理卫生得分分别为（85.8±11.4）、（65.4±16.7）、（82.3±14.5）、（80.3±10.8）、（88.8±13.6）、（93.1±4.9）、（85.9±12.5）、（82.5±7.3）分,均明显高于对照组的（54.7±20.3）、（30.5±14.2）、（61.9±17.5）、（28.1±11.5）、（46.3±18.2）、（53.4±15.2）、（34.8±15.3）、（46.7±14.1）分,差异均有统计学意义（均P〈0.05）。结论急性肺脓肿在常规内科治疗基础上配合纤维支气管镜肺泡灌洗可显著改善患者病情,缩短疗程,降低住院费用,避免手术治疗带来的创伤及痛苦,安全性良好,有效提高生活质量,值得临床推广。

Objective To explore the clinical effects and influence of life quality of fiber bronchoscope local lavage in the treatment of acute lung abscess.Methods 110 cases of acute lung abscess from September 2012 to June 2013 were selected and randomly divided into control group and treatment group（n=55）.The patients in control group were treated with regular medicine comprehensive treatment,including sensitive antibiotics combined with postural drainage,wet airway,expectorant,atomization treatment,symptomatic treatment of complications and systemic nutritional support.On the basis of control group,the patients in treatment group were treated with alveolar lavage by bronchoscopy mirror,local drug delivery.The hospital time,lung rale extinction time,vomica extinction time,temperature recovery time,cough and expectoration relief time,clinical curative effect,changes of arterial blood gas indexes before and after treatment were recorded and compared.At the time of 6 months follow-up,use SF-36 health questionnaires to evaluate the quality of life.Measurement data between groups was processed by t test,in groups was processed by paired t test,count data was processed by chi square test,P0.05 was considered statistically significant.Results The total effective rate of treatment group was 100.0%,significantly higher than that of the control group（61.8%）,the difference was statistically significant（P0.05）.The length of hospital stay,lung rale disappear time,vomica extinction time,temperature recovery time,cough and expectoration relief time of treatment group were（16.1±2.4）,（11.8±1.6）,（13.9±1.5）,（6.1±0.4）,（10.9±0.9）d,superior than that of the control group [（22.3±2.9）,（17.9±2.8）,（19.6±2.8）,（9.1±0.6）,（14.8±2.3） d],the differences were statistically significant（all P0.05）.After treatment,the FEV1,FVC and Pa O2 of treatment group and control group were（3.26±0.38）,（3.86±0.18） L,（80.9±7.3）mm Hg（1 mm Hg=0.133 k Pa）,（2.86±0.19）,（3.24±0.21）L,（70.9±2.3）mm Hg,superior than that before treatment[（2.19±0.27）,（2.41±0.29） L,（61.5±1.0）mm Hg,（2.12±0.34）,（2.39±0.36）L,（61.2±1.3）mm Hg],the differences were statistically significant（all P0.05）.6 months after hospital discharge,the score of physiological function,physiological functions,physical pain,energy,social function,mental health of treatment group were（85.8±11.4）,（65.4±16.7）,（82.3±14.5）,（80.3±10.8）,（88.8±13.6）,（93.1±4.9）,（85.9±12.5）,（82.5±7.3）points,significantly higher than that of control group[（54.7±20.3）,（30.5±14.2）,（61.9±17.5）,（28.1±11.5）,（46.3±18.2）,（53.4±15.2）,（34.8±15.3）,（46.7±14.1）points],the differences were statistically significant（all P0.05）.Conclusion Acute lung abscess on the basis of routine medical treatment with synthetic fiber with mirror alveolar lavage can significantly shorten the treatment course,reduce hospitalization expenses,avoid the surgical treatment of the trauma and pain,good security,improve the quality of life,worth clinical promotion