纤维支气管镜肺泡灌洗联合乙酰半胱氨酸局部注入治疗重症肺炎的效果及安全性

Efficacy and Safety of Bronchoalveolar Lavage Combined with Local Injection of Acetylcysteine in Treatment of Patients with Severe Pneumonia

目的探讨纤维支气管镜肺泡灌洗联合乙酰半胱氨酸局部注入治疗重症肺炎的效果及安全性。方法选取2018年12月—2020年8月收治的重症肺炎80例,据治疗方法的不同分为观察组和对照组,每组40例。对照组予纤维支气管镜肺泡灌洗联合布地奈德雾化吸入,观察组予纤维支气管镜肺泡灌洗联合乙酰半胱氨酸局部注入。治疗2周后比较两组疗效,治疗前后第1秒用力呼气容积(FEV1)、最大呼气峰流量(PEF)、FEV1/用力肺活量(FVC)、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、免疫球蛋白A(IgA)、IgG和IgM水平,以及治疗期间不良反应情况。结果观察组临床总有效率高于对照组(P<0.05)。治疗后,两组FEV1、PEF、FEV1/FVC、IgA、IgG和IgM水平较治疗前升高,且观察组上述指标高于对照组(P<0.01)。治疗后,两组TNF-α、IL-4较治疗前降低,且观察组上述指标低于对照组(P<0.05,P<0.01)。两组治疗期间不良反应总发生率比较差异无统计学意义(P>0.05)。结论纤维支气管镜肺泡灌洗联合乙酰半胱氨酸局部注入治疗重症肺炎效果显著,可有效提高患者肺功能,减轻机体炎症反应程度,改善免疫功能,且治疗安全性良好。

Objective To investigate efficacy and safety of bronchoalveolar lavage combined with local injection of Acetylcysteine in treatment of patients with severe pneumonia.Methods Eighty patients with severe pneumonia admitted during December 2018 and August 2020 were selected and divided into observation group(n=40)and control group(n=40)according to different treatment methods.Control group was given bronchoalveolar lavage combined with Budesonide Aerosol inhalation,while observation group was given bronchoalveolar lavage combined with local injection of Acetylcysteine.After 2 weeks of treatment,curative effect was compared,and values of forced expiratory volume in the first second(FEV1),peak expiratory flow(PEF),FEV1/forced vital capacity(FEV1/FVC),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),immunoglobulin(Ig)A,IgG and IgM levels before and after treatment were also compared,and incidence rate of adverse reactions during treatment was compared between two groups.Results The total effective rate in observation group was significantly higher than that in control group(P<0.05).After treatment,levels of FEV1,PEF,FEV1/FVC,IgA,IgG and IgM were significantly higher than those before treatment in two groups,and the above indexes in observation group were significantly higher than those in control group(P<0.01).After treatment,TNF-αand IL-4 levels were significantly lower than those before treatment in two groups,and the above indexes in observation group were significantly lower than those in control group(P<0.05,P<0.01).There was no significant difference in the total incidence rate of adverse reactions during treatment between two groups(P>0.05).Conclusion Bronchoalveolar lavage combined with local injection of Acetylcysteine is effective in treatment of patients with severe pneumonia,which may effectively improve lung function,reduce degree of inflammatory reaction and improve immune function with good safety.