纤维支气管镜灌洗疗法对老年重症肺炎患者的疗效及血降钙素原、C反应蛋白水平的影响

Curative efficacy of bronchoalveolar lavage with fiberoptic bronchoscopy in the treatment of severe pneumonia in the elderly and its effect on serum levels of PCT and CRP

目的探讨老年重症肺炎患者治疗中大剂量盐酸氨溴索联合纤维支气管镜灌洗疗法对临床疗效及PCT、CRP水平的影响。方法 2013年6月至2015年3月我院就诊的94例老年重症肺炎患者。按随机数字表法分为对照组41例和观察组53例。对照组采用常规氨溴索治疗,观察组采用纤维支气管镜灌洗联合大剂量盐酸氨溴索治疗。比较两组治疗前后血常规、血降钙素原(PCT)和C反应蛋白(CRP)水平;动脉血氧饱和度(SpO_2)、动脉氧分压(PaO_2)和氧合指数(PaO_2/FiO_2);慢性健康状况(APACHE II)评分、急性生理学,呼吸机带机时间、ICU天数、多器官功能衰竭(MOF)发生率、28 d死亡率、机械通气时间、肺部症状消失时间、血象恢复正常时间和体温恢复时间。结果观察组治疗7 d后CRP水平低于对照组,治疗3、7 d后PCT水平低于对照组(P<0.05)。观察组治疗3、7 d后PaO_2/FiO_2水平高于对照组(P<0.05)。观察组治疗7 d后APACHI II评分低于对照组,机械通气时间、28 d病死率、MOF发生率、肺部症状消失时间、血象恢复正常时间和体温恢复时间均低于对照组(P<0.05)。结论大剂量盐酸氨溴索联合纤维支气管镜灌洗治疗可使氧合情况明显改善,降低病死率、多器官衰竭发生率,缩短呼吸机带机时间,无明显不良反应,值得临床推广。

Objective To investigate the clinical efficacy of bronchoalveolar lavage with fiberoptic bronchoscopy and its impact on serum levels of PCT and CRP in the treatment of severe pneumonia in the elderly. Methods We selected 94 elderly patients with severe pneumonia in our hospital between June 2013 and March 2015. The patients were randomly divided into control group （n =41 ） and observation group （ n = 53） according to digital table method. The control group was detained by traditional dose ambroxel while the observation group was detained by high-dose ambroxol combined with fiberoptic bronchoscopy. The inflammatory index such as routine blood test,PCT and CRP,blood gas analysis such＇as SpO2 ,PaO2 and PaO2/FiO2 ,prognostic index such as the APACHE II score, ventilator time, ICU duration, MOF rate,28 day mortality, mechanical ventilation time, lung symptom disappearance time, hemogram recovery time and temperature recovery time were compared between the two groups. Results The CRP level on the 7 th day after treatment in the observation group was lower than that in the control group （P 〈 0. 05）. The PCT level on the 3rd day and the 7 th day after treatment in the observation group was significantly lower than that in the control group （P 〈 0. 05 ）. The PaO2/FiO2 level on the 3rd day and the 7 th day after treatment in the observation group was significantly higher than that in the control group （ P 〈 0. 05 ）. The APACH II score on the 7 th day after treatment in the observation group was significantly lower than that in the control group （P 〈 0. 05）. The ventilator time, ICU duration, MOF rate,28 day mortality, mechanical ventilation time, lung symptom disappearance time, hemogram recovery time and temperature recovery time was significantly lower or shorter than those in the control group （ P 〈 0. 05 ）. Conclusion High dose of ambroxol combined with bronchoalveolar lavage using fiberoptic bronchoscopy can significantly improve oxygenation,reduce the mortality rate and the incidence of organ failure and shorten ventilation time. There are no obvious adverse reactions. It is worthy of clinical promotion.