支气管镜肺泡灌洗用于重症肺炎患者的效果分析

Effect analysis of bronchoscopy lavage for patients with severe ventilator-associated pneumonia

目的:探究支气管镜肺泡灌洗用于重症肺炎、呼吸衰竭患者的临床效果。方法:研究对象选取为我院中心ICU 2013-01-2015-12收治的100例重症肺炎,呼吸衰竭,行气管插管、呼吸机通气支持患者,随机分为观察组和对照组各50例,对照组采用常规吸痰+灌洗治疗,观察组则采用纤维支气管镜进行肺泡灌洗,分别对2组患者的首次痰培养阳性率进行统计对比,记录2组患者治疗前后的呼吸力学参数并进行对比,根据培养结果进行抗感染治疗,对比治疗效果。结果:治疗前2组患者的气道峰压、动态顺应性、气道阻力及呼吸做功等参数比较差异无统计学意义,治疗后观察组改善显著优于对照组(P<0.05);观察组首次痰培养阳性率及治疗总有效率分别为78.0%和98.0%,对照组则分别为60.0%和80.0%,2组比较差异有统计学意义(P<0.05)。结论:支气管镜肺泡灌洗能够有效有效改善患者的呼吸力学参数,提高病原菌检测效率,为临床治疗提供必要参考,提高临床疗效,值得在临床上推广和应用。

Objective：To explore the clinical effect of bronchoscopy lavage for severe pneumonia in patients with respiratory failure.Method：The subjects were chose during 2013.01 to 2015.Twelve from central ICU of our hospital.100 cases of severe pneumonia,respiratory failure,endotracheal intubation,ventilator support were randomly divided into observation group and control group.Fifty patients in the control group were given conventional suction lavage treatment.Fifty patients in the conventional group were given bronchoscopy lavage.Respiratory mechanics parameters were compared between the two groups of patients before and after treatment.Anti-infective therapy was given based on culture result.Result：Before treatment,there was no difference for parameters between the two groups including peak airway pressure dynamic compliance,airway resistance and work of breathing parameters.The observation group was significantly improved after treatment than the control group（P〈0.05）.In the observation group,the first sputum culture positive rate and total effective rate were 78.0% and 98.0%,respectively.In the control group the first sputum culture positive rate and total effective rate were 60.0% and80.0%.The difference was significant（P〈0.05）.Conclusion：The bronchoscopy lavage can effectively improve respiratory mechanics parameters of patients,improve the efficiency of pathogen detection,provide the necessary reference for clinical treatment and improve the clinical efficacy,which may be worthy of promotion and application in clinical practice.