纤维支气管镜肺泡灌洗术治疗重症肺炎的疗效及对患者炎症因子和呼吸力学指标的影响

Effect of fibromyalgiabronchoscopic alveolar lavage in the treatment of severe pneumonia and its influence on inflammatory factors and respiratory mechanics

目的探讨纤维支气管镜肺泡灌洗术治疗重症肺炎的疗效及对患者炎症因子和呼吸力学指标的影响。方法选择2016年1月至2019年10月期间蒲城县医院收治的110例重症肺炎合并呼吸衰竭患者为研究对象,根据随机数表法分为观察组和对照组,每组55例,对照组患者接受抗感染、机械通气等常规治疗,观察组患者则在此基础上联合应用纤维支气管镜肺泡灌洗术治疗。比较两组患者治疗前及治疗3 d后的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)水平以及呼吸力学指标[气道阻力(Raw)、呼吸做功(WOB)及动态顺应性(Cdyn)]。出院时评价临床疗效。结果治疗前,两组患者血清TNF-α、IL-6、IL-8水平比较差异均无统计学意义(P>0.05);治疗后,观察组患者的血清TNF-α、IL-6、IL-8水平分别为(18.24±4.51)ng/L、(3.21±0.89)ng/L、(5.86±1.97)ng/L,明显低于对照组的(24.31±3.90)ng/L、(5.33±1.75)ng/L、(8.21±2.42)ng/L,差异均有统计学意义(P<0.05);治疗前,两组患者的Cdyn、Raw、WOB比较差异均无统计学意义(P>0.05);治疗后,观察组患者的Cdyn、Raw、WOB分别为(35.52±5.03)mL/cmH2O、(9.21±1.89)cmH2O/(L·s)、(0.36±0.11)J/L,明显优于对照组的(27.17±4.64)mL/cmH2O、(12.13±2.08)cmH2O/(L·s)、(0.58±0.19)J/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85.45%,明显高于对照组的72.73%,差异有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗治疗重症肺炎可以改善患者的呼吸功能,抑制炎症反应,进而提高临床疗效。

Objective To investigate the effect of fibromyalgiabronchoscopic alveolar lavage in the treatment of severe pneumonia and its influence on inflammatory factors and respiratory mechanics.Methods A total of 110 patients with severe pneumonia and respiratory failure treated in Pucheng County Hospital from January 2016 to October 2019 were selected as the study objects.According to the random number table method,they were divided into the observation group(n=55)and the control group(n=55).The control group received routine treatment such as antibiotic anti infection,mechanical ventilation,and the observation group was treated with fibromyalgiabronchoscopic alveolar lavage.The levels of tumor necrosis factorα(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),respiratory mechanics indexes(airway resistance[Raw],respiratory work[WOB],and dynamic compliance[Cdyn])were compared before and after treatment.The clinical effect was evaluated at discharge.Results Before treatment,there was no statistically significant difference in TNF-α,IL-6,and IL-8 between the two groups(P>0.05);after treatment,the TNF-α,IL-6,and IL-8 levels in the observation group were(18.24±4.51)ng/L,(3.21±0.89)ng/L,(5.86±1.97)ng/L,respectively,which were significantly lower than(24.31±3.90)ng/L,(5.33±1.75)ng/L,(8.21±2.42)ng/L in the control group(P<0.05).Before treatment,there was no statistically significant difference in Cdyn,Raw,WOB between the two groups(P>0.05);after treatment,Cdyn,Raw,and WOB in the observation group were(35.52±5.03)mL/cmH2O,(9.21±1.89)cmH2O/(L·s),(0.36±0.11)J/L,as compared with(27.17±4.64)mL/cmH2O,(12.13±2.08)cmH2O/(L·s),(0.58±0.19)J/L in the control group(P<0.05).The total effective rate of the observation group was 85.45%,significantly higher than 72.73%of the control group(P<0.05).Conclusion Fibromyalgiabronchoscopic alveolar lavage in the treatment of severe pneumonia can improve the respiratory function of patients with severe pneumonia,inhibit the inflammatory reaction,and improve the clinical effect.