纤维支气管镜灌洗辅助抗感染治疗对重症肺部感染患者肺功能、血气指标及炎症因子水平的影响

Effect of fiberoptic bronchoscopy as adjuvant therapy of anti-infective treatment on pulmonary function, blood gas index, and inflammatory factor levels in patients with severe pulmonary infection

目的探究重症肺部感染行纤维支气管镜灌洗辅助抗感染治疗的效果及对患者肺功能、血气指标、炎症因子的影响。方法选取2016年2月至2018年7月期间西安市北方医院收治的156例重症肺部感染患者为研究对象,按随机数表法分为对照组和观察组各78例。两组患者均给予常规治疗及抗感染治疗,观察组在此基础上结合纤维支气管镜灌洗治疗,持续治疗10 d。比较两组患者的临床疗效及治疗前、治疗10 d后的肺功能[最大通气量(MMV)、肺总量(TLC)、1 s用力呼气量(FEV1)、最大呼气中期流量(MMEF)]、血气指标[动脉血氧饱和度(SaO2)、动脉氧分压(PaO2)、二氧化碳分压(PaCO2)]、炎症因子[巨噬细胞炎症蛋白-1α(MIP-1α)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]水平。结果治疗前两组患者的肺功能、血气指标、炎症因子水平比较差异均无统计学意义(P>0.05);治疗后,观察组患者的MMV、TLC、FEV1、MMEF、SaO2、PaO2分别为(95.64±12.38)L、(5.34±0.73)L、(2.97±0.41)L、(3.23±0.54)L/s、(93.21±12.23)%、(82.57±10.64)mmHg,明显高于对照组的(84.27±10.63)L、(4.51±0.62)L、(2.21±0.29)L、(2.42±0.45)L/s、(84.19±10.57)%、(71.43±9.52)mmHg,差异均有统计学意义(P<0.05);治疗后,观察组患者PaCO2、MIP-1α、PCT、TNF-α、hs-CRP依次为(40.15±6.03)mmHg、(21.09±4.28)pg/mL、(0.49±0.09)ng/mL、(135.42±17.08)ng/L、(9.86±2.12)mg/L,明显低于对照组的(49.61±6.48)mmHg、(35.91±5.72)pg/mL、(0.98±0.17)ng/mL、(163.74±20.02)ng/L、(13.52±2.98)mg/L,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率为93.59%,明显高于对照组的78.21%,差异有统计学意义(P<0.05)。结论纤维支气管镜灌洗联合抗感染治疗重症肺部感染更有助于改善患者肺功能及血气指标,抑制炎症反应,提高治疗效果。

Objective To investigate the effect of fiberoptic bronchoalveolar lavage assisted anti-infective therapy on pulmonary function, blood gas index, and inflammatory factors in patients with severe pulmonary infection.Methods A total of 156 patients with severe pulmonary infection, who admitted to the Xi’an North Hospital from February 2016 to July 2018 were selected as subjects. According to random number table method, the patients were divided into the control group and the observation group, with 78 patients in each group. Both groups were given routine treatment and anti-infective treatment, and the observation group was treated additionally with fiberoptic bronchoscopy for lavage treatment. The course of treatment was 10 days. The clinical efficacy of the two groups of patients and the lung function(maximum ventilation [MMV], total lung volume [TLC], forced expiratory volume of 1 s [FEV1], mid-maximal expiratory flow [MMEF]), blood gas indicators(arterial oxygen saturation [SaO2], arterial oxygen partial pressure[PaO2], carbon dioxide partial pressure [PaCO2]), inflammatory factors(macrophage inflammatory protein-1α [MIP-1α],procalcitonin [PCT], tumor necrosis factor-α [TNF-α], high-sensitivity C-reactive protein [hs-CRP]) levels before treatment and after 10 days of treatment were compared between the two groups. Results There were no significant differences in lung function, blood gas index, and inflammatory factor between the two groups before treatment(all P>0.05).After treatment, MMV, TLC, FEV1, MMEF, SaO2, and PaO2 in the observation group were(95.64±12.38) L,(5.34±0.73) L,(2.97±0.41) L,(3.23±0.54) L/S,(93.21±12.23)%,(82.57±10.64) mmHg, respectively, which were higher than corresponding(84.27±10.63) L,(4.51±0.62) L,(2.21±0.29) L,(2.42±0.45) L/S,(84.19±10.57)%,(71.43±9.52) mmHg in the control group(all P<0.05);PaCO2, MIP-1α, PCT, TNF-α, and hs-CRP in the observation group were(40.15 ± 6.03) mmHg,(21.09±4.28) pg/mL,(0.49±0.09) ng/mL,(135.42±17.08) ng/L,(9.86 ± 2.12) mg/L, respectively, which were lower than corresponding(49.61±6.48) mmHg,(35.91±5.72) pg/mL,(0.98±0.17) ng/mL,(163.74±20.02) ng/L,(13.52±2.98) mg/L in the control group(all P<0.05). The total effective rate of treatment in the observation group was 93.59%, versus 78.21% in the control group(P<0.05). Conclusion Fiberoptic bronchoalveolar lavage combined with anti-infection treatment of severe pulmonary infection is more helpful to improve lung function and blood gas index, inhibit inflammation and improve treatment effect.