床旁支气管镜治疗在外科重症监护病房机械通气患者中的应用

The application of bedside bronchoscopy in patients with mechanical ventilation in surgical intensive care

目的回顾性分析床旁支气管镜技术在外科重症监护病房机械通气患者中的临床应用价值.方法选取2017年1月至12月行外科手术治疗并于术后转入重症监护病房(ICU),且机械通气时间>24h、年龄>18周岁的患者,将其分为有支气管镜组(治疗组)和无支气管镜组(对照组),统计分析两组间ICU住院天数、日均住院费及病死率等的差异.结果 ICU住院天数治疗组较对照组有延长,且差异有统计学意义.治疗组较对照组在预防术后肺部感染的发生无明显优势,对术后肺部感染的控制有比较优势(78.26% vs 61.11%).亚组分析显示颅脑手术患者中治疗组37例,对照组46例,治疗组较对照组平均日费用有明显下降,且差异有统计学意义(P<0.05);病死率有明显下降, ICU住院天数有延长,但差异均无统计学意义(P>0.05);减少和控制术后肺部感染有比较优势,但差异无统计学意义(P>0.05).腹腔手术患者中,治疗组16例,对照组26例,两组间比较,ICU住院天数、平均日费用、病死率差异均无统计学意义(P>0.05).结论不同部位手术后仍机械通气患者床旁支气管镜技术临床疗效不一致,对急诊颅脑手术后患者可降低术后肺部感染发生率、病死率及日均费用,并有益于肺部感染的控制;对腹部手术患者,在未明确继发肺不张或严重肺部感染时,并无明确获益,应严格掌握适应证.

Objective To retrospectively analysis the value of beside bronchoscopy in patients with mechanical ventilation in the surgical intensive care unit. Methods From January 2017 to December 2017,patients who underwent surgical treatment and were transferred to intensive care unit (ICU)after operation and whose mechanical ventilation time was>24 hours and age was>18 years old were divided into bronchoscopy group(treatment group)and non-bronchoscopy group(control group). The differences of ICU hospitalization days,average daily hospitalization fee and mortality between the two groups were analyzed. Results ICU hospitalization days in the treatment group were longer than those in the control group,and the difference was statistically significant. Compared with the control group,the treatment group had no obvious advantage in preventing the occurrence of pulmonary infection after operation,and had a comparative advantage in controlling pulmonary infection after operation(78.26% vs 61.11%). Subgroup analysis showed that there were 37 cases in the treatment group and 46 cases in the control group. The average daily cost of the treatment group was significantly lower than that of the control group(P<0.05). The mortality rate was significantly lower and the length of ICU hospitalization days was prolonged,but the difference was not significant(P>0.05). There was a comparative advantage in reducing and controlling pulmonary infection after operation,but the difference was not significant(P>0.05). There were 16 cases in the treatment group and 26 cases in the control group. There were no significant differences in ICU hospitalization days,average daily cost and mortality between the two groups(P>0.05). Conclusion There is no accordance in the efficacy of beside bronchoscopy in patients with mechanical ventilation of different surgical parts. For patients received emergency cerebral surgery the use of beside bronchoscopy can reduce Incidence of postoperative pulmonary infection,mortality and average daily charge,and beneficial to the control of pulmonary infection for patients received abdomen surgery,there is no clear benefit when secondary pulmonary atelectasis or severe pulmonary infection is not identified,we should strictly master the indications.