支气管镜肺泡灌洗联合无创通气对重症肺炎患者血气分析指标及炎症因子水平的影响

Effects of bronchoalveolar lavage combined with noninvasive ventilation on blood gas analysis indexes and inflammatory factors in patients with severe pneumonia

目的分析支气管镜肺泡灌洗(BAL)联合无创通气(NIV)对重症肺炎患者血气分析指标及炎症因子水平的影响。方法抽取2017年5月至2019年5月于鄂尔多斯市中心医院接受治疗的重症肺炎患者60例进行研究,按随机数字表法以1∶1比例均分为对照组和研究组,每组30例。两组患者均给予常规治疗,对照组患者在此基础上使用NIV进行治疗,研究组患者则使用BAL联合NIV进行治疗。对比两组患者治疗2周后临床疗效,记录治疗前、治疗2周后肺功能指标[深吸气量(IC)、第1秒用力呼气量(FEV1)、用力肺活量(FVC)、每分钟最大通气量(MVV)、一氧化碳弥散量(DLCO)]、血气分析指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、动脉血酸碱度(pH)]、炎性指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、高迁移率族蛋白(HMGB-1)],并记录治疗期间并发症发生情况。结果治疗2周后,研究组治疗总有效率(93.33%)高于对照组(73.33%,P<0.05);治疗2周后,两组患者IC、FEV1、FVC、MVV、DLCO、PaO2、SaO2、pH较治疗前上升,而PaCO2、IL-6、TNF-α、PCT、HMGB-1水平较治疗前下降(P<0.05),且研究组患者上述指标与同期对照组比较,差异有统计学意义(P<0.05);治疗期间,研究组患者并发症发生率低于对照组(P<0.05)。结论应用支气管镜与无创通气联用治疗可显著提高重症肺炎患者肺功能、改善血气分析指标、降低炎症反应,且安全性较高,有很好的应用价值。

Objective To analyze the effects of bronchoalveolar lavage(BAL)combined with noninvasive ventilation(NIV)on blood gas analysis indexes and inflammatory factors in patients with severe pneumonia(SP).Methods Sixty patients with SP who were treated in Ordos Central Hospital from May 2017 to May 2019 were selected for the study.They were evenly divided into control group and study group according to the random number table method,with 30 cases in each group.Patients in the two groups were given conventional treatment,and patients in control group were treated with NIV on this basis while patients in study group were treated with BAL+NIV.The clinical efficacy was compared between the two groups after 2 weeks of treatment,and the lung function indicators[deep inspiratory capacity(IC),1 s forced expiratory volume(FEV1),forced vital capacity(FVC),maximum ventilation volume per minute(MVV),diffusion capacity for carbon monoxide of the lung(DLCO)],blood gas analysis indexes[arterial partial pressure of blood oxygen(PaO2),arterial partial pressure of blood carbon dioxide(PaCO2),arterial oxygen saturation(SaO2),arterial blood pH]and inflammatory indicators[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),procalcitonin(PCT),high mobility group protein(HMGB-1)]were recorded before treatment and after 2 weeks of treatment,and the occurrence of complications during treatment were recorded.Results After 2 weeks of treatment,the total effective rate of treatment in study group was significantly higher than that in control group(93.33%vs.73.33%,P<0.05).After 2 weeks of treatment,the IC,EFV1,FVC,MVV,DLCO,PaO2,SaO2 and PH in the two groups were significantly increased compared with those before treatment while the levels of PaCO2,IL-6,TNF-α,PCT and HMGB-1 were decreased significantly(P<0.05),and the above indicators in study group were significantly different from those in control group at the same period(P<0.05).During the treatment,the incidence rate of complications in study group was significantly lower than that in control group(P<0.05).Conclusions Bronchoscopy combined with noninvasive ventilation has significant effects in the treatment of SP patients,and it can significantly enhance lung function,improve blood gas analysis,and reduce inflammatory response,with high safety and good application value.