盐酸氨溴索联合纤维支气管镜吸痰治疗老年重症肺炎的疗效及对患者APACHEⅢ评分及氧合指数的影响

Efficacy of Ambroxol Hydrochloride Combined with Fiberoptic Bronchoscopy in the Treatment of Elderly Patients with Severe Pneumonia and its Effects on APACHE Ⅲ Score and Oxygenation Index

目的:观察盐酸氨溴索联合纤维支气管镜吸痰治疗老年重症肺炎的疗效及对急性生理和慢性健康状况评分系统III(APACHEIII)评分及氧合指数的影响。方法:选取我院呼吸重症与危重科90例老年重症肺炎患者,按照入院顺序单双号分为两组,各45例,对照组采取常规剂量盐酸氨溴索联合振动排痰仪方案进行治疗,观察组采取大剂量盐酸氨溴索联合纤维支气管镜吸痰方案,比较两组治疗前后炎性指标[C反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)]、肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、第1秒用力呼气容积占用力肺活量百分比(FEV1%)]、APACHEIII评分、氧合指数、恢复进程(呼吸机带机时间、住ICU时间)、住院期间多器官功能衰竭(MOF)与28d病死率。结果:观察组治疗1周后CRP、WBC、PCT水平均显著低于对照组(P<0.05),FEV1、FVC、FEV1%均显著高于对照组(P<0.05);观察组APACHEIII评分明显低于对照组(P<0.05),氧合指数明显高于对照组(P<0.05);观察组呼吸机带机时间与住ICU时间均短于对照组(P<0.05),住院期间MOF发生率、28d病死率低于对照组(P<0.05)。结论:盐酸氨溴索联合纤维支气管镜吸痰治疗老年重症肺炎,可获得良好疗效,促进患者肺功能恢复,减轻机体炎症,改善预后,降低病死率。

Objective:To observe the efficacy of ambroxol hydrochloride combined with fiberoptic bronchoscopy in the treatment of elderly patients with severe pneumonia and its effects on acute physiology and chronic health evaluation III(APACHEIII)score and oxygenation index.Methods:A total of 90 elderly patients with severe pneumonia in our hospital were selected and divided into two groups according to the odd and even admission sequence,with 45 cases in each group.Control group was treated with conventional dose of ambroxol hydrochloride combined with vibration sputum elimination,and observation group was treated with high-dose ambroxol hydrochloride combined with fiberoptic bronchoscopy.The inflammatory indexes [C-reactive protein(CRP),white blood cell count(WBC),procalcitonin(PCT)],pulmonary function indexes[1st forced expiratory volume(FEV1),forced vital capacity(FVC),percentage of 1st forced expiratory volume in forced vital capacity(FEV1%)],APACHE III score,oxygenation index,recovery process(mechanical ventilation duration,ICU stay),multiple organ failure(MOF)during hospitalization and 28d mortality rate were compared between the two groups before and after treatment.Results:The levels of CRP,WBC and PCT in observation group were significantly lower than those in control group after 1w of treatment(P<0.05)while the FEV1,FVC and FEV1% were significantly higher than those in control group(P<0.05).The APACHEIII score in observation group was significantly lower than that in control group(P<0.05)while the oxygenation index was significantly higher than that in control group(P<0.05).The mechanical ventilation duration and ICU stay in observation group were shorter than those in control group(P<0.05),and the incidence rate of MOF during hospitalization and 28d mortality rate were lower than those in control group(P<0.05).Conclusion:Ambroxol hydrochloride combined with fiberoptic bronchoscope sputum aspiration in the treatment of senile severe pneumonia can obtain good curative effect,promote the recovery of pulmonary function,reduce inflammation,improve prognosis and reduce mortality.