纤维支气管镜灌洗对重型颅脑损伤后肺部感染患者预后的影响

Effect of fiberoptic bronchoscopic lavage on prognosis of patients with pulmonary infection after severe craniocerebral injury

目的探讨纤维支气管镜灌洗对重型颅脑损伤并发肺部感染患者的治疗效果,分析这种治疗方式对预后的影响。方法纳入本院收治的重型颅脑损伤后肺部感染患者90例,随机将其分成对照组与观察组各45例。对照组采用常规治疗,观察组在对照组基础上加用纤维支气管镜肺泡灌洗治疗,反复灌洗4次。比较两组治疗效果,观察治疗前、后白介素-6 (IL-6)、白介素-2受体(IL-2R)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平,并分析治疗前、后动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PCO_(2))、氧合指数(OI)变化情况,记录两组治疗期间不良反应发生率与死亡率。结果观察组总有效率为95.56%(43/45),高于对照组的80.00%(36/45),差异有统计学意义(P<0.05);观察组治疗后的血清IL-6、CRP、TNF-α低于对照组,组间比较有统计学意义(P<0.05);观察组治疗后的PaO_(2)、OI高于对照组,PCO_(2)低于对照组,两组比较差异显著(P<0.05);观察组死亡率为2.22%(1/45),较对照组的11.11%(5/45)差异无统计学意义(P>0.05)。结论纤维支气管镜灌洗能减轻重型颅脑损伤患者肺部感染的炎症程度,改善肺通气状态,值得临床推广。

Objective To investigate the effect of fiberoptic bronchoscopic lavage in the treatment of pulmonary infection after severe craniocerebral injury and to analyze the effect of this treatment on the prognosis.Methods 90 patients with pulmonary infection after severe craniocerebral injury were randomly divided into 45 cases in the control group and the observation group.The control group was treated with routine treatment,and the observation group was treated with bronchoalveolar lavage with fiberoptic bronchoscope on the basis of the control group,and repeated lavage for 4 times.Comparison of therapeutic effects of two groups were observed before and after treatment,interleukin-6(IL-6),interleukin-2 receptor(IL-2 R)and C reactive protein(CRP),tumor necrosis factor alpha(TNF-alpha)level,and analysis before and after treatment,arterial oxygen pressure(PaO_(2)),arterial partial pressure of carbon dioxide(PCO_(2)),oxygenation index(OI)changes and adverse reactions during the treatment in the two groups and the incidence rate of mortality.Results The total effective rate of the observation group was 95.56%,which was higher than that of the control group(80.00%),and the difference was statistically significant(P< 0.05).The serum IL-6,CRP and TNF-alpha in the observation group were lower than those of the control group,and there was a significant difference between the groups(P< 0.05).The PaO_(2) and OI in the observation group were higher than those in the control group,and the PCO_(2) was lower than the control group.The difference between the two groups was significant(P<0.05).The mortality rate of the observation group was 2.22%(1/45),and there was no significant difference in the 11.11%(5/45)of the control group(P>0.05).Conclusions Fiberoptic bronchoscopic lavage can reduce the inflammation of pulmonary infection in patients with severe craniocerebral injury and improve pulmonary ventilation status,which is worthy of clinical promotion.