纤维支气管镜肺泡灌洗在治疗机械通气下卒中患者相关性肺炎的应用研究

Application research of alveolar lavage of fiberoptic bronchoscope in treating ventilator-associated pneumonia of patients with stroke under mechanical ventilation

目的:研究纤维支气管镜肺泡灌洗在治疗机械通气下卒中患者相关性肺炎(SAP)中的应用。方法:选取收治的94例机械通气下SAP患者,采用随机双盲法将其分为对照组和观察组,每组47例。对照组接受改良吸痰法治疗,观察组在对照组基础上联合使用纤维支气管镜肺泡灌洗治疗,比较两种方法临床治疗效果。结果:两组治疗前C反应蛋白(CRP)、白介素8(IL-8)、前降钙素(PCT)、白细胞(WBC)等验证指标对比,差异无统计学意义;治疗完成后观察组4项验证指标均低于对照组,差异有统计学意义(t=22.037,t=19.563,t=11.606,t=4.402;P<0.05);观察组气道阻力(Raw)和峰值吸气压力(PIP)低于对照组,而肺动脉顺应性(Cpa)指标高于对照组,差异有统计学意义(t=18.073,t=6.281,t=24.341;P<0.05);两组菌株检出率对比,差异无统计学意义,而观察组细菌清除率、患者生存率均高于对照组,差异有统计学意义(x^2=12.922,t=4.810;P<0.05)。结论:对机械通气下SAP患者采用纤维支气管镜肺泡灌洗治疗,可有效减轻患者炎症水平,提高患者生存率,同时缩短患者住院时间、减少住院费用。

Objective: To study the application of alveolar lavage of fiberoptic bronchoscope in treating strokeassociated pneumonia(SAP) of patients with stroke under mechanical ventilation. Methods: A total of 94 patients with SAP who underwent mechanical ventilation in our department were selected and they were divided into control group(47 cases) and observation group(47 cases) by random and double-blind method. The control group was treated with modified sputum-suction method. The observation group was treated with alveolar lavage of fiberoptic bronchoscope on the basis of the control group. And the clinically therapeutic effects of the two methods were observed and compared. Results: The CRP, IL-8, PCT, WBC and other verification indexes pre treatment between the two groups were no significantly. After treatment, these indexes of observation group were significantly lower than those of control group(t=22.037, t=19.563, t=11.606, t=4.402, P>0.05), respectively. The airway resistance(Raw) and airway peak pressure(PIP) of observation group were significantly lower than those of control group, while the pulmonary artery compliance(Cpa) of observation group was significantly higher than that of control group(t=18.073, t=6.281, t=24.341, P<0.05). The detectable rate of bacterial strain between two groups was no significant(P>0.05), while the clearance rate and survival rate of observation group were significantly higher than those of control group(x^2=12.922, t=4.810, P<0.05). Conclusion: The treatment of alveolar lavage of fiberoptic bronchoscopy for patients with SAP under mechanical ventilation can effectively alleviate the level of inflammation, and improve the survival rate of patients. And at the same time, it can shorten the time of hospitalization, and reduce the cost of hospitalization.