纤维支气管镜下肺泡灌洗治疗支气管扩张合并感染的效果及对血气指标、血清炎症指标水平的影响

Effect of BAL on bronchiectasia with infection and its effects on blood gas and serum inflammatory factors

目的探讨支气管肺泡灌洗(BAL)治疗支气管扩张(BE)合并感染的疗效及对血气指标、血清炎性指标水平的影响。方法选取阿克苏地区第一人民医院于2015年1月~2016年12月收治的120例BE合并感染患者进行研究。采用随机数字表法将患者分为两组,对照组60例患者采用基础治疗措施,治疗组60例患者在对照组治疗的基础上加用纤维支气管镜下BAL方法治疗。测定并比较两组患者治疗前后的血气指标和血清炎性指标水平,疗程结束后对比评价两组的临床疗效。结果治疗前,两组的动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、氧合指数(PaO_2/FiO_2)水平对比,差异无统计学意义(P>0.05);治疗后,治疗组的PaO_2、PaO_2/FiO_2水平高于对照组(P<0.05),PaCO_2水平低于对照组(P<0.05);治疗前,两组的TNF-α、超敏C反应蛋白(hs-CRP)、白细胞介素-2(IL-2)、IL-4、IL-23、转化生长因子-β(TGF-β)的水平对比,差异无统计学意义(P>0.05);治疗后,治疗组的IL-2水平高于对照组(P<0.05),TNF-α、hs-CRP、IL-4、IL-23、TGF-β的低于对照组(P<0.05);治疗后,治疗组的显效率(58.33%)高于对照组(41.67%)(P<0.05)。结论支气管扩张合并感染患者的血清炎症因子水平和血气水平在BAL治疗后得到明显的改善,临床效果较好值得推广应用。

Objective To investigate the effect of bronchoalveolar lavage （BAL） on bronchiectasia（BE） with infection and its influence on the levers of blood gas indexes and serum inflammatory indexes. Methods From January 2015 to December 2016, 120 patients came from the First People′s Hospital of Aksu for treatment of BE with infection were selected as the study object. They were divided into groups by random number table. 60 patients of control group were treated with basic treatment measures, 60 patients of treatment group were treated with BAL under fiberoptic bronchoscope on the basis treatment of the control group. The blood gas indexes and serum inflammatory indexes of the two groups were measured before and after treatment, and the clinical efficacy was evaluated at the end of the course. The blood gas index, serum inflammatory index and clinical effective rate were compared between the two groups before and after treatment. Results Before treatment, the levels of arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon dioxide （PaCO2） and ]oxygenation index （PaO2/FiO2） in the two groups were not statistically significant （P 〉 0.05）; after treatment, the levels of PaO2 and PaO2/FiO2 in the treatment group were higher than those in the control group （P 〈 0.05）, and PaCO2 was lower than that in the control group （P 〈 0.05）. Before treatment, the levels of TNF-α, Hypersensitivity C reactive protein （hs-CRP）, Interleukin -2 （IL-2）, IL-4, IL-23 and transforming growth factor-β （TGF-β） in the treatment group and the control group were not statistically significant （P 〉 0.05）; After treatment, the level of IL-2 in the treatment group was higher than that in the control group （P 〈 0.05）, and the levels of TNF-α, hs-CRP, IL-4, IL-23 and TGF-β in the treatment group were lower than those in the control group （P 〈 0.05）. After treatment, the effective rate of the treatment group was 58.33%, which was higher than control group 41.67% （P 〈 0.05）. Conclusion Serum inflammatory factor levels and blood gas level of BE and infection can be improved after BAL treatment, it is worthy of clinical application.