经支气管镜肺泡灌洗治疗重症CAP患者的疗效及安全性

Efficacy and Safety of Bronchoalveolar Lavage in the Treatment of Severe CAP

目的探讨支气管镜肺泡灌洗对重症CAP患者的疗效及安全性。方法选择2016年8月至2018年11月在昆明医科大学附属甘美医院(昆明市第一人民医院)呼吸与危重症医学科接受治疗的76例重症CAP患者进行研究,将所有患者按照1~76数字顺序排序,随机分为治疗组及对照组,每组38例,对照组根据重症CAP诊断及治疗标准,常规抗感染等治疗,治疗组在原有基础上加用支气管镜肺泡灌洗治疗。观察7d后2组患者体温波动,白细胞,血气分析(PaO2及PaCO2),以及总住院时间。同时了解2组患者住院期间是否有严重不良事件发生。结果 2组患者经治疗,体温[治疗组(37.082±0.7822)℃,对照组(37.603±0.7779)℃]、白细胞[治疗组(9.058±1.8232)×10^9,对照组(11.41±0.0599)×10^9]、PaCO2治疗组[(42.84±6.092) mmHg,对照组(48.63±6.162) mmHg]均有下降,差异有统计学意义(P<0.05)。治疗后,2组比较,治疗组优于对照组,差异有统计学意义(P<0.05)。PaO2均有上升[治疗组(82.12±8.867) mmHg,对照组(67.87±9.154) mmHg],对比治疗前,差异有统计学意义(P<0.05)。治疗后,2组比较,治疗组优于对照组,差异有统计学意义(P<0.05)。住院时间[治疗组(13.97±3.537) d,对照组(20.19±3.763) d],治疗组少于对照组,差异有统计学意义(P<0.05)。结论对重症CAP患者使用支气管镜肺泡灌洗治疗,临床疗效显著,未发现严重不良反应,安全性较好。

Objective To study the efficacy and safety of bronchoalveolar lavage in the treatment of patients with severe CAP.Methods 76 patients with severe CAP were selected from August,2016 to November,2018 in Ganmei Hospital Affiliated to Kunming Medical University(The First People’s Hospital of Kunming).All patients were randomly divided into 2 groups:treatment group(n = 38) and control group(n = 38).The treatment group was treated with bronchoscopy and alveolar lavage. After 7 days, body temperature fluctuation, white blood cell,blood gas analysis(PaO2 and PaCO2) and total hospitalization time were observed.At the same time,we observedwhether there were serious adverse events during hospitalization in the two groups.Results After treatment,body temperature[treatment group(37.082±0.7822) ℃,control group(37.603±0.7779) ℃], white blood cell[treatment group(9.058±1.8232) ×10^9,control group(11.41±.0599) ×10^9] and PaCO2[treatment group(42.84±6.092) mm Hg,control group(48.63±6.162) mm Hg] were decreased in the two groups, and the difference was statistically significant(P<0.05).At the same time, the effect of bronchofiberscope lavage in the treatment group was more significant, and the decrease was more obvious, the difference was statistically significant(P <0.05).After treatment, PaO2[treatment group(82.12 ±8.867) mmHg, control group(67.87 ±9.154) mmHg ]increased, and the difference was statistically significant compared with that before treatment(P<0.05).At the same time, the curative effect of bronchoscopy lavage in the treatment group was better and the increase was more significant than the control group, the difference was statistically significant(P<0.05).Hospitalization time[treatment group(13.97±3.537) d,control group(20.19 ±3.763) d]of patients in the treatment group was shorter than that in the control gorup, the difference was statistically significant(P<0.05).Conclusion Bronchoscope alveolar lavage has significant clinical effect and no serious adverse reactions in the treatment of patients with severe CAP.