支气管肺泡灌洗辅助治疗重症肺炎合并呼吸衰竭的疗效及对炎性因子、肺功能的影响

Effectiveness of Bronchoalveolar Lavage in Adjunctive Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure and Its Effect on Inflammatory Factors and Pulmonary Function

目的探讨支气管肺泡灌洗辅助治疗重症肺炎合并呼吸衰竭的效果及对患者炎性因子、肺功能的影响。方法选取2017年1月—2018年12月我院收治的重症肺炎合并呼吸衰竭患者78例,根据治疗方法的不同均分为观察组和对照组,每组39例。对照组予常规治疗,观察组在对照组基础上加用支气管肺泡灌洗,2组均连续治疗5 d。比较2组临床疗效,治疗前后血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、动脉血二氧化碳分压(PaCO 2)、动脉血氧饱和度(SaO 2)、动脉血氧分压(PaO 2)、pH、第1秒用力呼气容积占预计值百分比(FEV1%)、呼气流量峰值(PEF)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)及并发症发生情况。结果观察组临床总有效率明显高于对照组(P<0.05)。2组治疗后血清IL-10、TNF-α及CRP水平均降低,且观察组低于对照组(P<0.05,P<0.01)。2组治疗后PaCO 2、SaO 2、PaO 2较治疗前改善,且观察组改善程度较对照组更显著,差异有统计学意义(P<0.01)。2组治疗后FEV1%、PEF、FEV1/FVC明显升高,且观察组高于对照组(P<0.01)。观察组在支气管肺泡灌洗过程中9例(23.08%)一过性血氧饱和度下降,并伴心动过速及心律失常,给予吸氧后恢复正常,无严重并发症发生。结论支气管肺泡灌洗辅助治疗重症肺炎合并呼吸衰竭患者,可增强治疗效果,有效减轻机体炎性反应,改善肺功能,且临床安全性较好。

Objective To investigate effectiveness of bronchoalveolar lavage(BAL)in adjunctive treatment of patients with severe pneumonia complicated with respiratory failure and its effects on inflammatory factors and pulmonary function.Methods A total of 78 patients with severe pneumonia complicated with respiratory failure who had been admitted during January 2017 to December 2018 were divided into observation group and control group(n=39 in each group)according to different therapeutic methods.Control group was given conventional treatments,while observation group was added with bronchoalveolar lavage on the basis of treatment for control group.Time of continuous course treatment was 5 d in two groups.Clinical effectiveness,serum interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),arterial partial pressure of carbon dioxide(PaCO 2),arterial oxygen saturation(SaO 2),arterial partial pressure of oxygen(PaO 2),pH,percentage of forced expiratory volume in one second(FEV1%),peak expiratory flow(PEF)and the first second use of The percentage of forced expiratory volume to forced vital capacity(FEV1/FVC)and incidence rate of complications before and after treatment were compared in two groups.Results Clinical total effective rate in observation group was significantly higher than that in control group(P<0.05).After treatment,levels of serum IL-10,TNF-αand CRP were decreased in two groups,and the above indexes in observation group were significantly higher than those in control group,and the differences were statistically significant(P<0.05,P<0.01);PaCO 2,SaO 2 and PaO 2 values were improved in the two groups,and improvement degrees of the values in observation group were more obvious than those in control group,and the differences were statistically significant(P<0.01);FEV1%,PEF and FEV1/FVC values were significantly increased in two groups,and the above indexes in observation group were higher than those in control group(P<0.01).During treatment of bronchoalveolar lavage,9 patients(23.08%)had transient decrease of blood oxygen saturation accompanied by tachycardia and arrhythmia,but they returned to normal after oxygen inhalation,and no serious complications occurred.Conclusion Bronchoalveolar lavage in adjunctive treatment of patients with severe pneumonia complicated with respiratory failure may enhance therapeutic effect,effectively reduce inflammatory reaction of body and improve lung function with good safety in clinic.