支气管肺泡灌洗对难治性肺炎的疗效观察

Observation of curative effect by bronchoalveolar lavage for refractory pneumonia

目的探讨纤维支气管镜下支气管肺泡灌洗对难治性肺炎的疗效和安全性。方法 90例难治性肺炎患者随机分为治疗组和对照组,各45例。对照组给予常规治疗,治疗组在对照组治疗基础上给予纤维支气管镜下支气管肺泡灌洗治疗。观察两组的治疗总有效率、住院时间、治疗费用、治疗前后白细胞介素6（IL-6）和C反应蛋白（CRP）水平及不良反应方面的差异。结果治疗后,治疗组患者的总有效率为97.8%,高于对照组的73.3%（P〈0.05）;治疗组患者的住院时间（19.39±2.67）d明显短于对照组的（24.35±3.65）d,治疗费用（3.53±1.64）万元少于对照组的（6.37±3.26）万元,比较差异具有统计学意义（P〈0.05）;治疗后,两组IL-6、CRP水平均较治疗前显著降低,且治疗组下降情况优于对照组,差异均具有统计学意义（P〈0.05）。治疗组10例患者出现呛咳,大多轻微,无需特殊处理;2例出现低氧血症,停止灌洗并退出支气管镜后,给予3~5 L/min氧气吸入后指脉氧很快恢复90%以上;对照组无严重不良反应发生。结论纤维支气管镜下支气管肺泡灌洗治疗难治性肺炎具有良好的疗效及安全性。

Objective To investigate curative effect and safety by fiber bronchoscopic bronchoalveolar lavage for refractory pneumonia. Methods A total of 90 refractory pneumonia patients were randomly divided into treatment group and control group, with 45 cases in each group. The control group received conventional therapy, and the treatment group received additional fiber bronchoscopic bronchoalveolar lavage. Observation was made on total effective rate, hospital stay time, treatment cost, interleukin-6（IL-6）, C-reactive protein（CRP） levels and adverse reaction between the two groups. Results After treatment, the treatment group had high total effective rate as 97.8% than 73.3% of the control group（P〈0.05）, its hospital stay time was much shorter as（19.39±2.67） d than（24.35±3.65） d of the control group, and its treatment cost was much less as（35.30±16.40） thousand yuan than（63.70±32.60） thousand yuan of the control group. Their difference had statistical significance（P〈0.05）. The After treatment, both groups had obviously lower IL-6 and CRP levels than those before treatment, and the treatment group had better decreasing state than the control group. Their difference had statistical significance（P〈0.05）. There were 10 bucking cases with mild symptoms and no special treatment and 2 hyoxemia cases with recovery of pulse oxygen over 90% after ceased lavage, bronchoscope withdrawal, and oxygen inhalation by 3~5 L/min. There was no case with severe adverse reactions in the control group. Conclusion Fiber bronchoscopic bronchoalveolar lavage provides precisely curative effect and safety in treating refractory pneumonia.