床边支气管镜吸痰联合肺泡灌洗治疗高龄老年肺部感染的临床研究

Clinical Study on Treatment of Senile Pulmonary Infection with Bedside Bronchoscope Suction and Alveolar Lavage

目的探讨床边电子支气管镜在高龄老年(≥80岁)肺部感染患者治疗中的疗效、安全性。方法方便收集2014年10月—2016年12月在上海中冶医院住院并确诊为肺部感染的高龄老年患者100例,按就诊顺序据随机数字表法将其分为研究组和对照组,各50例。对照组给予传统方法常规治疗和按需吸痰。研究组在给予传统方法常规治疗和按需吸痰基础上,每周加用1~2次床边电子支气管镜吸痰联合支气管肺泡灌洗。结果研究组肺炎链球菌检出19例(38.00%),肺真菌检出5例(10.00%),金黄色葡萄球菌检出8例(16.00%),绿脓杆菌检4例(8.00%)均较对照组高(χ~2=9.801,11.785,10.105,13.655),差异无统计学意义(P>0.05);研究组咳痰转归平均时间为10 d,1周白细胞计数恢复达62.96%,第1周影像学恢复16例,第2周影像学恢复13例,治疗有效率达到90.00%,不良反应发生率10.00%,均优于对照组,差异有统计学意义(P<0.05)。结论床边电子支气管镜吸痰联合支气管肺泡灌洗术对高龄老年肺部感染患者的治疗具有积极作用,不良反应少。

Objective This paper tries to explore the efficacy and safety of bedside electronic bronchoscopy in the treatment of pulmonary infection in elderly（≥80 years）. Methods Convenient select 100 elderly patients were admitted to Shanghai Zhongye Hospital from October 2014 to December 2016 and were diagnosed as having pulmonary infection. According to the order of visits, they were divided into study group and control group according to the random number table method, 50 cases each. The control group was given traditional methods of routine treatment and on-demand sucking. On the basis of routine treatment and on-demand sputum suction, the study group used bedside electronic bronchoscope suctioning combined with bronchoalveolar lavage 1 to 2 times a week. Results The study group detected 19 cases（38.00%） of Streptococcus pneumoniae, 5 cases（10.00%） of pulmonary fungus, 8 cases（16.00%） of Staphylococcus aureus, and 4 cases（8.00%） of Pseudomonas aeruginosa. The control group was high（χ~2=9.801, 11.785, 10.105, 13.655）, and the difference was not statistically significant（P〉0.05）. The study group had an average cough history of 10 days, and the white blood cell count recovered to 62.96% in the first week. Imaging was restored in 16 cases, and in the 2 nd week, 13 cases were image-recovered, and the treatment effective rate was 90.00%. The adverse reaction rate was 10.00%, which was better than the control group. the difference was significant（P〈0.05）. Conclusion Bedside electronic bronchoscope suctioning combined with bronchoalveolar lavage has a positive effect on the treatment of elderly patients with pulmonary infections, with fewer adverse reactions.