纤维支气管镜肺泡灌洗对机械通气卒中相关性肺炎的影响

Study of Fiberoptic Bronchoscopy and Alveolar Lavage on Mechanical Ventilation-related Stroke Pneumonia

目的探讨纤维支气管镜肺泡灌洗对机械通气下卒中相关性肺炎患者的炎性因子、细菌菌谱分布的影响及疗效观察。方法 2014年1月至2018年1月,随机选取我院收治的卒中相关性肺炎患者160例作为研究对象,对所有患者开展纤维支气管镜肺泡灌洗,分析患者的细菌培养结果、炎性因子以及疗效。结果治疗后,患者的总有效率为93. 75%。对比治疗前,治疗后患者的炎性因子指标改善显著,P<0. 05;细菌培养阳性率为62. 5%,分离出100株病原菌,其中细菌有75株,占75%,其中革兰阳性菌25株,占33. 33%,革兰阴性菌50例,占66. 67%,真菌25株,占25%。结论纤维支气管镜肺泡灌洗可有效提高卒中相关性肺炎患者的临床效果,改善炎性因子,同时卒中相关性肺炎患者主要病原菌为革兰阴性菌,耐药性较高,临床上可结合病原学分析给予患者合理使用抗生素,值得临床深究。

Objective To investigate the effect of fiberoptic bronchoscopy on the distribution of inflammatory factors and bacterial strains in patients with stroke-related pneumonia under mechanical ventilation.Methods 160 patients with stroke-associated pneumonia admitted to our hospital from January 2014 to January 2018 were randomly selected as the study subjects.Fiberoptic bronchoscopy alveolar lavage was performed on all patients.The bacterial culture results and inflammatory factors and efficacy were analyzed.Results After treatment,the total effective rate of the patient was 93.75%.Before the treatment,the inflammatory factor index of the patients improved significantly after treatment(P<0.05),the positive rate of bacterial culture was 62.5%,100 strains of pathogens were isolated,in which 75 strains accounted for 75%,25 strains were Gram-positive bacteria accounting for 33.33%,50 cases of Gram-negative bacteria accounting for 66.67%and 25 strains of fungi accounting for 25%.Conclusion Fiberoptic bronchoscopy alveolar lavage can effectively improve the clinical effect of stroke-associated pneumonia patients and improve inflammatory factors.At the same time,the main pathogens of patients with stroke-associated pneumonia are Gram-negative bacteria,which have high drug resistance and can be combined with pathogens clinically.It is worthy of clinical study to give patients reasonable use of antibiotics.