经支气管肺泡灌洗联合异帕米星局部用药治疗老年支气管扩张感染的临床研究

Bronchoalveolar Lavage Combined with Local Application of Isepamicin in the Treatment of Bronchiectasis Infection in the Elderly

目的探讨电子支气管镜下行肺泡灌洗术后联合异帕米星局部用药治疗老年支气管扩张症合并急性感染的临床疗效,为治疗该病提供有效的方法。方法选取2015年11月—2017年10月我院收治的支气管扩张症合并感染患者84例,随机分成试验组和对照组,每组42例。2组均采用常规治疗措施,对照组在支气管镜下病变部位肺泡灌洗,试验组在对照组治疗基础上给予异帕米星局部用药治疗。评估并比较2组的疗效、实验室指标变化及不良反应情况。结果治疗后试验组热退时间、咳脓痰消失时间、静脉抗生素应用时间和住院时间均明显少于对照组(P<0.05);治疗前2组动脉血气指标(PaO2、PaCO2和SaO2)、氧合指数(PaO2/FiO2)、炎症指标(CRP、PCT和WBC)差异均无统计学意义(P>0.05),治疗后2组的氧合功能改善指标(PaO2、SaO2、PaO2/FiO2)均显著高于治疗前,CRP、PCT、WBC水平均显著低于治疗前(P<0.05);且试验组的PaO2、SaO2和PaO2/FiO2水平均明显高于对照组,CRP、PCT、WBC水平均明显低于对照组,差异均有统计学意义(P<0.05);2组不良反应情况差异无统计学意义(P>0.05)。结论经支气管镜肺泡灌洗病变部位联合异帕米星局部用药治疗老年支气管扩张伴感染,能够明显改善患者的症状,缩短康复时间、抗生素应用的时间及住院时间,显著改善血气、氧合指数以及炎症指标,提高了临床疗效,且不良反应可控,具有一定的临床应用价值。

Objective To discuss the clinical curative effect of bronchoalveolar lavage under electronic bronchoscope combined with local application of isepamicin on bronchiectasis infection in the elderly.Methods 42 cases with bronchiectasis complicated by infection during the period from Nov.,2015 to Oct.,2017 were selected and randomly divided into 2 groups: experiment group and control group,42 in each;routine treatment and bronchoalveolar lavage of lesions under electronic bronchoscope were made to the cases in both groups while local application of isepamicin was added to cases in experiment group;the curative effect,the changes of lab test index and the occurrence of adverse reactions were analyzed and a comparative study was made between the 2 groups.Results After treatment,the time of fever retreat,the time of coughing with no purulent sputum,the time intravenous application of antibiotics and hospitalization in experiment group were all shorter than those in control group (P<0.05);before treatment,the arterial blood gas indexes (PaO2,PaCO2,SaO2),the oxygenation index (PaO2/FiO2) and the inflammatory indexes (CRP,PCT,andWBC) of the cases in the 2 groups were of no statistical difference (P>0.05) while after treatment,the levels of oxygenation improvement index (PaO2,SaO2 and PaO2/FiO2) were much higher and the levels of CRP,PCT and WBC were much lower in both groups than those before treatment;the levels of PaO2, SaO2 and PaO2/FiO2 were obviously higher and the levels of CRP,PCT and WBC were obviously lower in experiment group than those in control group,and the difference was of statistical significance (P<0.05);no statistical difference was found in the occurrence of adverse reactions between the 2 groups (P>0.05).Conclusions The treatment of bronchoalveolar lavage under electronic bronchoscope combined with local application of isepamicin for the elderly with bronchiectasis complicated by infection can effectively improve the symptoms,shorten the time of recovery,application of antibiotics and hospitalization, improve the arterial blood gas indexes,the oxygenation index and the inflammatory indexes and promote the clinical curative effect with less adverse reactions,it is of certain value in clinical application.