纤维支气管镜肺灌洗联合无创正压通气治疗重症肺部感染的临床效果及其对炎性因子的影响研究

Clinical Effect of Fiberoptic Bronchoscopy Lung Lavage Combined with Non-invasive Positive Pressure Ventilation on Severe Pulmonary Infection and the Impact on Inflammatory Cytokines

目的探讨纤维支气管镜肺灌洗联合无创正压通气治疗重症肺部感染的临床效果及其对炎性因子的影响。方法选取2015年1月—2016年1月河北省沧州中西医结合医院收治的重症肺部感染患者102例,按随机数字表法分为对照组与观察组,每组51例。对照组患者予以常规治疗,观察组患者在常规治疗基础上予以纤维支气管镜肺灌洗联合无创正压通气治疗;两组患者均连续治疗15 d。比较两组患者治疗前后炎性因子〔C反应蛋白(CRP)、白介素6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)〕水平、血气分析指标(氧分压、二氧化碳分压)及呼吸频率,并发症发生情况,心脏不良事件发生情况及再次入院情况。结果治疗前两组患者CRP、IL-6、IL-8、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后观察组患者CRP、IL-6、IL-8、TNF-α水平低于对照组(P<0.05)。治疗前两组患者氧分压、二氧化碳分压、呼吸频率比较,差异无统计学意义(P>0.05);治疗后观察组患者氧分压高于对照组,二氧化碳分压、呼吸频率低于对照组(P<0.05)。观察组患者并发症发生率、心脏不良事件发生率、再次入院率低于对照组(P<0.05)。结论支气管镜肺灌洗联合无创正压通气可有效缓解重症肺部感染患者临床症状,降低炎性因子水平,改善血气分析指标,且安全性较高。

Objective To analyze the clinical effect of fiberoptic bronchoscopy lung lavage combined with non - invasive positive pressure ventilation （NIPPV） on severe pulmonary infection and the impact on inflammatory cytokines. Methods A total of 102 patients with severe pulmonary infection were selected in the Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine from January 2015 to January 2016, and they were divided into control group and observation group according to random number table, each of 51 cases. Patients of control group received conventional treatment after admission, while patients of observation group received fiberoptic bronchoscopy lung lavage combined with NIPPV based on conventional treatment; both groups continuously treated for 15 days. Inflammatory cytokines （including CRP, IL-6, IL-8 and TNF-α）, bloodgas analysis index （including PaO2 and PaCO2 ） and respiratory rate before and after treatment, incidence of complications and adverse cardiac events, and readmission condition were compared between the two groups. Results No statistically significant differences of CRP, IL-6, IL-8 or TNF-α was found between the two groups before treatment （ P 〉 0. 05）, while CRP, IL-6, IL-8 and TNF-α of observation group was statistically significantly lower than that of control group after treatment （P 〈 0.05 ）. No statistically significant differences of PaO2, PaCO2 or respiratory rate was found between the two groups before treatment （P 〉 0. 05 ） ; after treatment, PaO2 of observation group was statistically significantly higher than that of control group, while PaCO2 and respiratory rate of observation group were statistically significantly lower than those of control group （P 〈 0.05 ）. Incidence of complications and adverse cardiac events, and readmission rate of observation group was statistically significantly lower than that of control group, respectively （ P 〈 0. 05 ）. Conclusion Fiberoptic bronchoscopy lung lavage combined with NIPPV can effectively relive the clinical symptoms of severe pulmonary infection patients, reduce the inflammatory cytokines and adjust the blood -gas analysis index, has relatively high safety. [