纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染患者中的临床研究

Clinical research of fiberoptic bronchoscopic sputum aspiration combined with alveolar lavage in patients with severe pulmonary infection

目的研究纤维支气管镜吸痰联合肺泡灌洗对重症肺部感染患者血气分析指标和炎性因子水平的影响。方法选取2019年10月至2020年12月德阳市人民医院收治的重症肺部感染患者170例,按照随机数字表法分为对照组和观察组,各85例,对照组患者实施平喘,止咳、抗感染、营养支持以及机械通气等常规治疗,观察组患者在对照组常规治疗的基础上实施纤维支气管镜吸痰联合肺泡灌洗治疗,两组患者均治疗14 d。比较两组患者治疗后临床疗效,体温恢复正常时间、咳嗽消失时间、血象异常症状转归时间,治疗前后血气分析指标与炎性因子水平。结果治疗后观察组患者的临床总有效率高于对照组;观察组患者的体温恢复正常时间、咳嗽消失时间、血象异常症状好转时间均短于对照组;与治疗前相比,治疗后两组患者动脉氧分压(PaO2)、血氧饱和度(SpO2)水平均升高,且观察组高于对照组,而两组患者动脉二氧化碳分压(PaCO2)、血清肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)及C-反应蛋白(CRP)水平均降低,且观察组低于对照组(均P<0.05)。结论重症肺部感染患者实施纤维支气管镜吸痰联合肺泡灌洗后,可有效改善临床症状和呼吸功能,降低体内炎性因子水平,且疗效显著。

Objective To investigate the effects of fiberoptic bronchoscopic sputum aspiration combined with alveolar lavage on blood gas analysis indexes and inflammatory factors in patients with severe pulmonary infection.Methods A total of 170 patients with severe pulmonary infection who were admitted to People's Hospital of Deyang City from October 2019 to December 2020 were selected,they were divided into the control group and the observation group according to random number table method,with 85 cases in each group.Patients in the control group were treated with the conventional treatment of antiasthmatic,antitussive and anti-infection,nutritional support and mechanical ventilation,while the patients in the observation group were treated with fiberoptic bronchoscopic sputum aspiration combined with alveolar lavage on the basis of the conventional treatment of the control group,both groups were treated for 14 days.The clinical efficacy after treatment,the time for body temperature return to return to normal,the time for cough disappearance,the time for abnormal blood symptoms to improve,blood gas analysis indexes and inflammatory factor levels of patients in the two groups before and after treatment were compared.Results The total effective rate of the observation group was higher than that of the control group;temperature return to normal time,cough disappear time and abnormal blood symptom improvement time in the observation group were shorter than those in the control group;compared with before treatment,the level arterial oxygen partial pressure(PaO2)and blood oxygen saturation(SpO2)levels of patients in two groups increased after treatment,and the observation group was higher than that in the control group,while the arterial carbon dioxide partial pressure(PaO2)and serum tumor necrosis factor-α(TNF-α),the levels of procalcitonin(PCT)and C-reactive protein(CRP)levels of patients in the two groups decreased,and the observation group was lower than those in the control group(all P<0.05).Conclusion Fiberoptic bronchoscopic sputum aspiration combined with alveolar lavage in patients with severe pulmonary infection can effectively shorten the time of symptom improvement,improve clinical symptoms and respiratory function,reduce the level of inflammatory factors,and improve the curative effect.