纤维支气管镜吸痰联合氨溴索治疗呼吸机相关性肺炎的临床疗效

Clinical Effect of Fiberoptic Bronchoscopy- guided Sputum Suction Combined With Ambroxol on Ventilator Associated Pneumonia

目的观察纤维支气管镜吸痰联合氨溴索治疗呼吸机相关性肺炎(VAP)的临床疗效。方法选取2010年1月—2014年5月宜兴市人民医院收治的在机械通气过程中发生VAP的患者46例,随机分为治疗组和对照组,各23例。两组患者均给予常规治疗,对照组患者给予氨溴索治疗,治疗组患者给予纤维支气管镜吸痰联合氨溴索治疗;两组患者均连续治疗10 d。比较两组患者临床疗效,治疗前后临床肺部感染评分(CPIS)、体温、炎性细胞(白细胞计数、淋巴细胞分数、粒细胞分数)及血清炎性因子〔降钙素原(PCT)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、C反应蛋白(CRP)〕水平,并观察治疗期间两组患者不良反应/并发症发生情况。结果治疗组患者临床疗效优于对照组(P<0.05)。治疗前两组患者CPIS、体温、白细胞计数、淋巴细胞白分数及粒细胞分数比较,差异均无统计学意义(P>0.05);治疗后治疗组患者CPIS评分、白细胞计数、淋巴细胞分数及粒细胞分数低于对照组(P<0.05);治疗后两组患者体温比较,差异无统计学意义(P>0.05)。治疗前两组患者血清PCT、TNF-α、IL-6及CRP水平比较,差异无统计学意义(P>0.05);治疗后治疗组患者血清PCT、TNF-α、IL-6及CRP水平低于对照组(P<0.05)。治疗期间两组患者均未出现明显不良反应/并发症。结论纤维支气管镜吸痰联合氨溴索治疗VAP的临床疗效确切,能有效改善患者感染症状,减轻炎性反应,且安全性较高。

Objective To observe the clinical effect of fiberoptic bronchoscopy - guided sputum suction combined with ambroxol on ventilator associated pneumonia. Methods A total of 46 patients with ventilator associated pneumonia were selected in the People＇s Hospital of Yixing from January 2010 to May 2015,and they were randomly divided into control group and treatment group,each of 23 cases. Based on conventional treatment,patients of control group received ambroxol,while patients of treatment group received fiberoptic bronchoscopy - guided sputum suction combined with ambroxol;both groups continuously treated for 10 days. Clinical effect, clinical pulmonary infection score （ CPIS ）, body temperature, inflammatory cells （including white blood cell count,lymphocyte percentage and granulocyte percentage） and serum inflammatory cytokines （including PCT,TNF-α,IL-6 and CRP）levels were compared between the two groups,and the incidence of adverse reactions/complications was observed. Results The clinical effect of treatment group was statistically significantly better than that of control group （ P ﹤ 0. 05 ）. No statistically significant differences of CPIS, body temperature, white blood cell count, lymphocyte percentage or granulocyte percentage was found between the two groups before treatment,nor was body temperature between the two groups after treatment（P ﹥ 0. 05）,while CPIS,white blood cell count,lymphocyte percentage and granulocyte percentage of treatment group were statistically significantly lower than those of control group after treatment（P ﹤ 0. 05）. No statistically significant differences of serum level of PCT,TNF-α,IL-6 or CRP was found between the two groups before treatment （P ﹥ 0. 05）,while serum levels of PCT,TNF-α,IL-6 and CRP of treatment group were statistically significantly lower than those of control group（P ﹤ 0. 05）. No one of the two groups occurred any obvious adverse reactions/ complications during the treatment. Conclusion Fiberoptic bronchoscopy - guided sputum suction combined with ambroxol has certain clinical effect in＆nbsp;treating patients with ventilator associated pneumonia,can effectively relive the infection symptoms and inflammatory reaction,is relatively safe.