纤维支气管镜治疗呼吸机相关性肺炎的临床应用

Clinical Application of Fiberoptic Bronchoscopy in Treatment of Ventilator Associated Pneumonia

目的研究纤维支气管镜在呼吸机相关性肺炎治疗中的应用价值.方法将云南省第三人民医院ICU内并发呼吸机相关性肺炎的168例重症患者随机分为治疗组、对照组,每组84例,均给予吸氧、抗炎、祛痰等治疗,治疗组使用纤维支气管镜灌洗,对照组采用吸痰管吸痰,观察2组患者吸痰后氧和的变化,治疗后CRP(超敏C反应蛋白)、PCT(降钙素原)及IL-6(白细胞介素-6)的变化;比较2组患者临床疗效、痰培养阳性率、抗生素使用时间及住ICU时间.结果与对照组比较,治疗组Sa O2(动脉血氧饱和度)、Pa O2(动脉氧分压)及氧合指数均明显改善(P<0.05);与对照组比较,治疗组治疗后CRP、PCT及IL-6均明显改善(P<0.05)治疗组总有效率明显高于对照组,治疗组抗生素使用时间、住ICU时间明显短于对照组(P<0.05).结论纤维支气管镜吸痰及灌洗治疗呼吸机相关性肺炎能够改善氧合,能缩短抗生素使用时间及住ICU时间,值得临床推广应用.

Objective To study the value of fiberoptic bronchoscopy in treatment of ventilator associated pneumonia. Methods The 168 cases of ventilator associated pneumonia in ICU were randomly divided into treatment group and control group,each group of 84 cases, were given oxygen, anti-inflammatory, expectorant treatment.Treatment group was given fiber bronchoscope sputum suction and irrigation, control group was given sputum suction tube, then we observed the oxygenation changes after sputum suction of two groups of patients, compared clinical efficacy,sputumculture positive rate,antibiotic using time and staying time in the ICU between two groups of patients. Results Compared with control group, in treatment group SaO2, PaO2 and oxygen index were significantly improved (P < 0.05) ; in treatment group CRP,PCT and IL-6 were significantly improved (P <0.05) . In the treatment group, the total effectiveness is significantly higher than the control group; antibiotic using time and staying time of ICU were obviously shorter than the control group (P < 0.05) . Conclusion Fiberoptic bronchoscopy irrigation treatment can improve oxygenation, antibiotic using time and staying time in ICU of ventilator associated pneumonia patients, and is worthy of clinical application.