纤支镜灌洗治疗吸入性肺炎并低氧血症效果观察

Bronchofiberoscope lavage in the treatment of aspiration pneumonia and hypoxemia

目的探讨纤维支气管镜(纤支镜)灌洗联合BiPAP通气治疗吸入性肺炎并低氧血症的临床观察及效果分析。方法选取2018年8月—2019年9月火箭军特色医学中心收治的88例吸入性肺炎患者为研究对象,随机分为试验组44例给予纤支镜灌洗联合BiPAP通气治疗;对照组44例;给予纤支镜灌洗治疗,观察2组治疗前后血氧分压(PaO_(2))指血氧分压、血氧饱和度(SaO_(2))、脉血二氧化碳分压(PaCO_(2))。比较2组的临床疗效及治疗前后血清肿瘤坏死因子-α(serumtumornecrosis factor-α,T NF-α)、白细胞介素-6(interleukin-6,IL-6)及白细胞介素-10(interleukin-10,IL-10)水平。并对2组患者进行APACHEⅡ分值评分。2组患者均接受常规治疗。结果治疗72h后试验组PaO_(2)、SaO_(2)明显优于对照组,而PaCO_(2)低于对照组差异有统计学意义(P<0.05)。试验组治疗后TNF-α、IL-6及IL-10水平均低于对照组(P<0.05)。对照组总有效率为59.09%,显著低于观察组的84.09%,差异具有统计学意义(P<0.05)。观察组APACHEⅡ分值显著低于对照组。结论纤支镜灌洗联合BiPAP通气治疗吸入性肺炎并低氧血症患者,可有效清除炎性因子,恢复血气指标,临床效果更优。

Objective To explore the clinical effect of fiberoptic bronchoscopic lavage combined with BiPAP ventilation in the treatment of aspiration pneumonia and hypoxemia.Methods Between August 2018 and September2019,88 patients with aspiration pneumonia admitted to our hospital were randomly divided into the experimental group(n=44)treated with fiberoptic bronchoscopic lavage combined with BiPAP ventilation and the control group(n=44)treated with fiberoptic bronchoscopic lavage.Arterial oxygen pressure(PaO_(2)),blood oxygen saturation(SaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))in the two groups were observed before and after treatment.The clinical efficacy and serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)before and after treatment were compared between the two groups.The APACHEⅡscores were recorded.Both groups of patients received conventional treatment.Results After 72 hours of treatment,PaO_(2)and SaO_(2)in the experimental group were significantly better than those of the control group,but PacO_(2)was lower.The difference between the two groups was statistically significant(P<0.05).After treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)in the experimental group were significantly lower than those of the control group(P<0.05).The total effective rate of the control group was 59.09%,which was significantly lower than 84.09%in the observation group,so the difference was statistically significant(P<0.05).The APACHE-II score of the observation group was significantly lower than that of the control group.Conclusion Bronchofiberoscope lavage combined with BiPAP ventilation in the treatment of patients with aspiration pneumonia and hypoxemia can effectively remove inflammatory factors and restore blood gas indicators with better clinical effects.