肺部超声指导下胸部物理治疗联合纤支镜肺泡灌洗对重症肺炎患者的影响

The clinical effects of ultrasound guided chest physiotherapy combined with bronchofiberscope alveolar lavage on severe pneumonia

目的探讨肺部超声指导下胸部物理治疗联合纤维支气管镜(纤支镜)肺泡灌洗对重症肺炎患者临床疗效的影响。方法观察2016年10月至2020年6月ICU就诊的重症肺炎的患者160例,分为对照组和观察组。对照组采用肺部超声指导下胸部物理联合抗感染治疗,观察组在此基础上采用纤支镜肺泡灌洗联合治疗,比较治疗14 d后2组患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、临床肺部感染(CPIS)评分、氧合指数(PaO2/FiO2)、血清炎性因子C-反应蛋白(CRP)与降钙素原(PCT)水平。结果治疗2周后,观察组临床总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前,2组患者APACHEⅡ评分、CPIS评分、PaO2/FiO2、血清CRP与PCT水平差异无统计学意义(P>0.05);治疗2周后,APACHEⅡ评分、CPIS评分较治疗前降低,且观察组低于对照组(P<0.05);PaO2/FiO2水平较治疗前增高,且观察组高于对照组(P<0.05);血清CRP及PCT水平较治疗前降低,观察组低于对照组,差异有统计学意义(P<0.05)。结论肺部超声指导的胸部物理治疗联合纤支镜肺泡灌洗可显著缓解重症肺炎患者病情,改善氧合,减轻炎性反应,临床疗效显著。

Objective To investigate the clinical effects of ultrasound guided chest physiotherapy combined with bronchofiberscope alveolar lavage on severe pneumonia.Methods A total of 160 patients with severe pneumonia who were treated in our hospital from October 2016 to June 2019 were randomly divided into control group and observation group.The patients in control group were treated by ultrasound guided chest physiotherapy combined with anti-infection,however,the patients in observation group,on the basis of control group,were treated by bronchofiberscope alveolar lavage,with a treatment course of 14 days for both groups.The acute physiology and chronic health marking systemⅡ(APACHEⅡ)score,clinical pulmonary infection score(CPIS),oxygenation index(PaO2/FiO2),serum inflammatory factor C reactive protein(CRP)and calcitonin(PCT)levels were observed and compared between the two groups.Results After 2-week treatment,the total clinical effective rate in observation group was significantly higher than that in control group(P<0.05).Before treatment there were no significant differences in APACHEⅡscores,CPIS scores,PaO2/FiO2,serum levels of CRP and PCT between the two groups(P>0.05).After 2-week treatment,APACHEⅡscores and CPIS scores in both groups were significantly decreased,moreover,which in observation group were significantly lower than those in control group(P<0.05).After treatment the levels of PaO2/FiO2 in both groups were significantly increased,but the serum levels of CRP and PCT were significantly decreased,moreover,the increase degree and increase degree in observeation group were more significant than those in control group(P<0.05).Conclusion The ultrasound guided chest physiotherapy combined with bronchofiberscope alveolar lavage can significantly relieve the illness condition of patients with severe pneumonia,improve oxygenation,reduce inflammation reaction,with significant clinical effects.