经纤维支气管镜灌洗治疗难治性肺部感染的疗效及其预后的影响因素分析

Efficacy of Bronchoalveolar Lavage in the Treatment of Refractory Pulmonary Infection and Analysis of Influencing Factors for Prognosis

目的 观察经纤维支气管镜灌洗(BAL)治疗难治性肺部感染疗效并分析影响预后的因素。方法 将2016年3月至2018年3月间于眉山市人民医院行Bla治疗的难治性肺部感染患者纳为研究对象,统计患者治疗效果,并根据疗效标准将其分为显效组(n=41)、有效组(n=84)与无效组(n=25),分析患者性别、年龄、合并基础性疾病种类、营养状况、器官功能衰竭情况、侵入性治疗及检查史、免疫功能与治疗效果间的关系,Logistic回归分析影响Bla治疗难治性肺部感染疗效的因素。结果 经纤维支气管镜取样病原菌培养阳性率为90%,Bla治疗难治性肺炎患者的有效率为83.33%,不良反应率为18.00%;单因素分析发现,除性别与术中不良反应外,显效组、有效组及无效组患者年龄、合并基础性疾病数目、器官衰竭数目、侵入性治疗及检查史、营养状况、细菌培养结果、双重混合感染、耐药性病菌、免疫功能及病程间均差异有统计学意义(P<0.05);经Logisitc回归分析发现,年龄≥75岁、合并基础性疾病≥5种、器官功能损伤≥3、营养状况差、免疫力低下、病程≥10d均是影响Bla治疗难治性肺部感染患者效果的独立危险因素。结论 BLA治疗难治性肺部感染安全性高性及有效率高、且治疗操作方便。

Objective To observe the efficacy of bronchoalveolar lavage (BAL) in the treatment of refractory pulmonary infection and analyze the influencing factors for prognosis. Methods Patients with refractory pulmonary infection who underwent BLA treatment in our hospital from March 2016 to March 2018 were included in the study. The treatment effects were counted,and the patients were classified into markedly effective group (n = 41), effective group (n=84) and ineffective group (n = 25) according to the efficacy criteria. The relationship between gender,age,combined basic disease types,nutritional status,organ failure,history invasive treatment and examination,immune function and treatment effects was analyzed among the patients. Logistic regression analysis was used to analyze the influencing factors for BLA efficacy in the treatment of refractory pulmonary infection. Results The positive rate of pathogenic bacteria cultured by fiberoptic bronchoscopy was 90%,and the effective rate of BLA for patients with refractory pneumonia was 83.33%,and the adverse reaction rate was 18.00%. Univariate analysis found that except for gender and intraoperative adverse reactions,there were significant differences in age,quantity of combined basic diseases,quantity of organ failures,history of invasive treatment and examination,nutritional status,bacterial culture results,double mixed infection,drug-resistant pathogens, immune function and disease duration among markedly effective group,effective group and ineffective group(P < 0.05). Logisitc regression analysis found that age≥75 years old, combined basic diseases ≥5 types, organ function damage ≥3, poor nutritional status, low immunity and disease course ≥10d were independent risk factors that affected the BLA treatment effects for patients with refractory pulmonary infection. Conclusion BLA has high safety,high effective rate and easy treatment operation in the treatment of refractory pulmonary infection.