纤维支气管镜肺泡灌洗联合局部抗生素治疗机械通气卒中相关性肺炎的效果观察

Observation on the efficacy of fiberoptic bronchoscopy alveolar lavage combined with local antibiotics in the treatment of stroke associated pneumonia caused by mechanical ventilation

目的探讨纤维支气管镜肺泡灌洗联合局部抗生素在机械通气卒中相关性肺炎(SAP)中的应用价值。方法选择2018年9月至2020年9月廉江市人民医院收治的机械通气SAP患者108例为研究对象,采用随机数字表法分为对照组和观察组。对照组采用纤维支气管镜肺泡灌洗治疗,观察组采用纤维支气管镜肺泡灌洗联合局部抗生素治疗。统计比较两组的炎症指标、呼吸功能指标和不良反应。结果两组治疗3 d后的CRP、PCT、TNF-α浓度均明显低于治疗前(P<0.05)。观察组治疗3 d后的CRP、PCT、TNF-α浓度均明显低于对照组(P<0.05)。与治疗前比较,两组治疗7 d后的氧合指数明显高,PaCO2和Raw均明显低(P<0.05)。与对照组比较,观察组治疗7 d后的氧合指数明显高,PaCO2和Raw均明显低(P<0.05)。两组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局部抗生素治疗机械通气SAP可提高抗炎效果,加快呼吸功能恢复。

Objective To investigate the application value of fiberoptic bronchoscopy alveolar lavage combined with local antibiotics in stroke associated pneumonia(SAP)caused by mechanical ventilation.Methods A total of 108 patients with SAP caused by mechanical ventilation admitted to Lian Jiang People's Hospital from September 2018 to September 2020 were selected as the research objects,and they were divided into the control group and the observation group according to the random number table method.The control group was treated with fiberoptic bronchoscopy alveolar lavage,while the observation group was treated with fiberoptic bronchoscopy alveolar lavage combined with local antibiotics.The inflammation indices,respiratory function indices and adverse reactions(ARs)of the two groups were compared statistically.Results The concentrations of C-reactive protein(CRP),procalcitonin(PCT)and tumor necrosis factor-α(TNF-α)in both groups after 3 days of treatment were all significantly lower than those before treatment(P<0.05).The concentrations of CRP,PCT and TNF-αin the observation group were all significantly lower than those in the control group after 3 days of treatment(P<0.05).Compared with those before treatment,the oxygenation indices of the two groups after 7 days of treatment were significantly higher,while partial pressure of carbon dioxide in artery(PaCO2)and Air way Resistance(Raw)were both significantly lower(P<0.05).Compared with that of the control group,the oxygenation index of the observation group after 7 days of treatment was significantly higher,while PaCO2 and Raw were both significantly lower(P<0.05).There was no statistically significant difference in the total incidence of ARs between the two groups(P>0.05).Conclusion Fiberoptic bronchoscopy alveolar lavage combined with local antibiotics can improve the antiinflammatory efficacy and accelerate the recovery of respiratory function.