支气管镜肺泡灌洗在广泛耐药不动杆菌肺炎中的治疗价值及血清IL-6、PCT的变化情况

The experience of bronchoalveolar lavage with bronchoscope in the treatment of pneumonia caused by extensively drug-resistant Acinetobacter and the changes of serum IL-6 and PCT

目的探讨支气管镜肺泡灌洗在广泛耐药不动杆菌肺炎中的治疗价值及血清IL-6、PCT的变化情况。方法选取2014年1月~2017年6月我院收治的50例肺炎患者作为研究对象,根据CPIS评分、PCT值并采用分层随机化分组法将患者分为A组和B组,每组各25例。A组患者给予美罗培南1 g以及哌拉西林舒巴坦3 g治疗,均每8 h静脉滴注1次,连续治疗2周。B组患者在应用A组抗生素治疗基础上,给予电子气管镜灌洗,每日或隔日1次(视患者痰量及耐受情况)。比较两组患者治疗前、治疗1、2周后的临床肺部感染评分、氧合指数、血清IL-6及PCT水平变化。结果治疗1周后,A组患者的各项指标与治疗前比较,差异无统计学意义(P>0.05);而B组患者的血清IL-6、PCT低于治疗前,PaO_2/FiO_2高于治疗前,差异有统计学意义(P<0.05),但CPIS评分与治疗前比较,差异无统计学意义(P>0.05)。治疗1周后,B组患者的血清IL-6、PCT明显低于A组,PaO_2/FiO_2明显高于A组,差异有统计学意义(P<0.05),B组患者的CPIS评分与A组比较,差异无统计学意义(P>0.05)。治疗2周后,A组患者的血清IL-6、PCT低于治疗前,PaO_2/FiO_2高于治疗前,差异有统计学意义(P<0.05),但CPIS评分与治疗前比较,差异无统计学意义(P>0.05);B组患者的血清IL-6、PCT、CPIS评分低于治疗前,PaO_2/FiO_2高于治疗前,差异有统计学意义(P<0.05)。治疗2周后,B组患者的血清IL-6、PCT、CPIS评分明显低于A组,PaO_2/FiO_2明显高于A组,差异有统计学意义(P<0.05)。结论对于广泛耐药不动杆菌肺部感染患者,支气管镜肺泡灌洗可较快降低血清IL-6、PCT,改善机体氧合,使临床症状缓解。

Objective To investigate the value of bronehoalveolar lavage （BAL） in the treatment of extensively resistant Acinetobaccer pneumonia and the changes of serum IL-6 and PCT.Methods The 50 patients with pneumonia treated in our hospital from January 2014 to June 2017 were selected and randomly divided into group A and group B according to CPIS seores,PCT values and stratified randomized grouping method,25 patients in each group.The patients in group A were treated with 1 g of Meropenem and 3 g of Piperaeillin and Sulbaetam,eaeh 8 h intravenous drip was injected 1 time,the patients were treated for 2 consecutive weeks.The patients in group B were given electronic endotraeheal tube lavage on the basis of antibiotic treatment of group A,daily or alternate days （depending on the amount of sputum and tolerance of the patient）.The clinical pulmonary infection score,oxygenation index,serum IL-6 and PCT level of the two groups were compared before and after treatment for 1 or 2 weeks.Results After 1 week of treatment,the indicators of group A were compared with those before treatment,and the differences were not statistically significant （P〉0.05）.The serum IL-6 and PCT of patients in group B were lower than before treatment,and the differences were statistically significant （P〈0.05）,but CPIS score was compared with that before treatment,the difference was not statistically significant （P〉0.05）.Afier 1 week of treatment,patients of group B with serum IL-6 and PCT were lower than those in group A,the PaOJFiO2 was significantly higher than that of group A, the differences were statistically significant （P〈0.05）,while the CPIS score of patients in group B was compared with group A,the difference was not statistically significant （P〉0.05）.After 2 weeks of treatment,the serum IL-6 and PCT of patients in group A were lower than before the treatment,the PaO2/FiO2 was higher than before the treatment,and the differences were statistically significant （P〈0.05）,but the CPIS score was compared with before treatment,the difference was not statistically significant （P〉0.05）.The serum IL-6,PCT and CPIS score in group B were lower than before treatment,while PaOJFiO2 was higher than before the treatment,and the differences were statistically significant （P〈0.05）.After 2 weeks of treatment,the serum IL-6,PCT and CPIS score in group B were significantly lower than those in group A,while the PaOJFiO2 was significantly higher than group A,and the differences were statistically significant （P〈0.05）.Conclusion For patients with lung infection caused by extensively drug-resistant A cinetobacter,bronchoalveolar lavage can rapidly decrease the serum levels of IL-6 and PCT,improve oxygenation and relieve the clinical symptoms.