纤支镜灌洗治疗肺炎合并脓毒症的临床疗效

Clinical efficacy of fiberoptic bronchoscopy in treatment of pneumonia patients complicated with sepsis and its effect on the level of CRP

目的对合并脓毒症的肺炎患者采用纤维支气管镜(纤支镜)肺泡灌洗治疗,研究观察灌洗治疗的疗效。方法选取在我院105例合并脓毒症的肺炎患者作为主要研究对象,均符合临床诊断标准。按照随机数字表法分为对照组52例(采用常规治疗方法),研究组53例(在对照组的基础上联合纤支镜肺泡灌洗治疗),2周为一个疗程,均治疗一个疗程。观察两组治疗前后的影像学改变,记录两组呼吸、血清白细胞计数(WBC)及体温变化,急性生理和慢性健康状况评分(APACHEⅡ),CRP水平;记录治疗后两组患者机械通气时间、ICU住院时间、退热时间。结果研究组总治疗有效率为90. 57%显著高于对照组的75. 00%(P <0. 05);治疗后两组患者的呼吸、血白细胞计数(WBC)、体温变化、APACHEⅡ评分均较治疗前有明显改善(P均<0. 05);且治疗2周后,研究组的各指标水平均低于对照组(P均<0. 01);两组治疗后1周、2周的CRP均较治疗前有明显改善(P均<0. 01);治疗后各时间点研究组的CRP水平均低于对照组(P均<0. 01);研究组机械通气时间、ICU住院时间、退热时间均明显少于对照组(P均<0. 01)。结论纤支镜肺泡灌洗治疗能够明显降低肺炎合并脓毒症患者的APACHEⅡ评分,改善临床影像学指标及症状,抑制CRP水平及炎症反应,治疗效果理想。

Objective To observe the clinical efficacy of fiberoptic bronchoscopy in treatment of pneumonia patients complicated with sepsis. Methods 105 pneumonia patients complicated with sepsis were selected and randomly divided into the control group （52 cases） and the study group （53 cases）. All patients were given conventional treatment, and the study group was additionally given fiberoptic bronchoscopy. They were all treated for 2 weeks as a course of treatment. Imaging changes and respiratory and serum leucocyte count （WBC） and body temperature changes, acute physiology and chronic health status （APACHE II） and CRP level were observed and compared between the two groups before and after treatment. The mechanical ventilation time, ICU hospital stay and fever time were recorded in the two groups after treatment. Results The total effective rate of the study group was 90.57%, which was significantly higher than that of the control group （75%） （ P〈 0.05）. The levels of serum white blood cell count after treatment （WBC） and the changes of temperature and APACHE score improved significantly after treatment （all P〈 0.05）, and they were lower in the study group than in the control group （all P〈 0.01） two weeks after treatment. The improvement of CRP was pronounced 1 and 2 weeks after treatment in the two groups （all P〈 0.01）. The time of ICU mechanical ventilation, hospital stay and pyretolysis was significantly shorter in the study group than in the control group （ P〈 0.01）. Conclusion Bronchoscopy lavage therapy can significantly reduce APACHE II score, improve clinical imaging indexes and symptoms and inhibit CRP levels and inflammatory response in treatment of pneumonia patients complicated with sepsis, which has high clinical application value.