纤维支气管镜在不间断机械通气重症肺炎诊治中的应用研究

Study on Application of Fiberoptic Bronchoscopy in the Diagnosis and Treatment of Severe Pneumonia with Continuous Mechanical Ventilation

目的分析纤维支气管镜(下文简称纤支镜)在不间断机械通气重症肺炎(SP)患者诊治中的应用价值。方法选择2015年2月-2019年2月新郑市人民医院收治的180例SP患者进行研究,纳入对象均接受不间断机械通气处理,以随机数表法分为两组,对照组用无菌吸痰管吸取分泌物,而观察组则予以纤支镜吸取分泌物。比较两组病原体培养阳性率、临床效果、机械通气时间、住院时间,以及治疗前后氧分压、氧合指数、C反应蛋白。结果观察组病原体培养阳性率更高,总有效率更高,机械通气时间与住院时间更短,与对照组差异显著(P<0.05);两组治疗前氧分压、氧合指数、C反应蛋白对比无显著差异(P>0.05),治疗后观察组氧分压、氧合指数更高,C反应蛋白更低,与对照组差异显著(P<0.05)。结论对不间断机械通气SP患者诊治中应用纤支镜辅助吸取分泌物进行培养与鉴定及治疗,相比无菌吸痰管处理可取得更好的效果,能提高病原体培养阳性率,更好地改善患者的氧分压、C反应蛋白等指标,同时可缩短患者机械通气时间与住院时间,提高临床效果,值得应用。

Objective To analyze the value of fiberoptic bronchoscopy in the diagnosis and treatment of severe pneumonia(SP)with continuous mechanical ventilation.Methods 180 patients with SP admitted to People's Hospital of Xinzheng from February 2015 to February 2019 were selected as the research objects.All subjects received continuous mechanical ventilation and were divided into two groups by random number table method.The control group was treated with aseptic sputum aspiration tube to suck secretions,while the observation group was treated with fiberoptic bronchoscopy to suck secretions.The positive rate of pathogen culture,clinical effect,mechanical ventilation time,hospital stay,and oxygen partial pressure,oxygenation index and C-Reactive Protein before and after treatment were compared between the two groups.Results The positive rate of pathogen culture and the total effective rate was higher in the observation group.Mechanical ventilation time and hospital stay were shorter in the observation group,which were significantly different from the control group(P<0.05).There was no significant difference in oxygen partial pressure,oxygenation index and C-Reactive Protein between the two groups before treatment(P>0.05).After treatment,the observation group had higher oxygen partial pressure and oxygenation index and lower C-Reactive Protein,which were significantly different from the control group(P<0.05).Conclusion Compared with the aseptic suction phlegm tube processing,applying Bronchofiberscope for sucking secretions to cultivate,identify and treat the SP patients who has continuous mechanical ventilation can not only improve the positive rate of bacterial culture,better improve the patient's oxygen partial pressure,and C-Reactive Protein,but also shorten the mechanical ventilation time and hospital stay,and improve clinical effect,which is worthy of clinical application.