纤维支气管镜吸痰联合肺泡灌洗对呼吸机相关性肺炎的疗效

Efficacy of fibrobronchoscope sputum suction combined with alveolar lavage in treatment of ventilator-associated pneumonia

目的观察纤维支气管镜吸痰联合肺泡灌洗对呼吸机相关性肺炎(VAP)的疗效。方法抽取2015年2月至2019年2月于开封市中心医院接受治疗的70例VAP患者为受试对象,采用随机数字表法将其分为观察组与对照组,每组35例。两组患者均给予基础治疗,对照组在其基础上给予常规灌洗吸痰治疗,观察组予以纤维支气管镜吸痰联合肺泡灌洗治疗。比较两组围治疗期指标(机械通气时间、肺部感染控制时间、抗菌药物使用时间、ICU入住时间),记录其治疗前、治疗7 d后呼吸力学指标、血气指标变化情况。结果观察组患者机械通气时间、肺部感染控制时间、抗菌药物使用时间、ICU入住时间均低于对照组(P均<0.05);治疗7 d后,两组患者呼吸做功(WOB)、气道峰压(PIP)、气道阻力(Raw)水平较治疗前均有下降(P<0.05),且观察组低于对照组(P<0.05),而两组动态顺应性(Cdyn)水平较治疗前上升(P<0.05),且观察组高于对照组(P<0.05);治疗7d后,两组患者动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)较治疗前均上升(P均<0.05),且观察组高于对照组(P<0.05);动脉血氧分压(PaO2)较治疗前均下降(P均<0.05),且观察组低于对照组(P<0.05)。结论纤维支气管镜吸痰联合肺泡灌洗治疗VAP疗效理想,较常规灌洗吸痰具有缩短机械通气时间、减少抗菌药物使用时间等优势,且更有利于患者呼吸功能的提高,值得临床推广。

Objective To observe the efficacy of fibrobronchoscope sputum suction combined with alveolar lavage in the treatment of ventilator-associated pneumonia(VAP).Methods Seventy patients with VAP who were treated in Kaifeng Central Hospital from February 2015 to February 2019 were selected as study subjects,and they were divided into observation group and control group according to the random number table method,35 cases in each group.The patients in the two groups were all given basic treatment,and control group was given conventional lavage andsputum suction on this basis,and observation group was given fibrobronchoscope sputum suction combined with alveolar lavage treatment.The perioperative indicators(mechanical ventilation time,pulmonary infection control time,antibacterial drug use time,ICU stay)were compared between the two groups,and respiratory mechanical indexes and blood gas indexes were recorded before treatment and after 7 days of treatment.Results The mechanical ventilation time,pulmonary infection control time,antibacterial drug use time and ICU stay in observation group were significantly lower than those in control group(P<0.05).After 7 days of treatment,the levels of work of breathing,peak inspiratory pressure and airway resistance in the two groups were significantly lower than those before treatment(P<0.05),and the levels in observation group were significantly lower than those in control group(P<0.05),and the dynamic compliance level in the two groups was significantly higher than that before treatment(P<0.05),and the level in observation group was significantly higher than that in control group(P<0.05).After 7 days of treatment,the partial pressure of arterial blood oxygen and arterial oxygen saturation in the two groups were significantly higher than those before treatment(P<0.05),and the indexes in observation group were significantly higher than those in control group(P<0.05).The partial pressure of arterial blood oxygen was significantly lower than that before treatment(P<0.05),and the index in observation group was significantly lower than that in control group(P<0.05).Conclusions Fibrobronchoscope sputum suction combined with alveolar lavage has ideal efficacy in the treatment of VAP.Compared with conventional lavage and sputum suction,it has the advantages of shortening the mechanical ventilation time and reducing the use time of antibacterial drugs.And it is more conducive to the improvement of respiratory function in patients,thus it is worth of clinical promotion.