纤支镜肺泡灌洗联合盐酸氨溴索治疗老年重症肺炎合并呼吸衰竭的疗效分析

Efficacy of Fiberoptic Bronchoalveolar Lavage Combined with Intravenous Drip of Ambroxol Hydrochloride in Treatment of Elderly Severe Pneumonia with Respiratory Failure

目的探讨纤支镜肺泡灌洗(BAL)联合盐酸氨溴索治疗老年重症肺炎合并呼吸衰竭(RF)的临床疗效.方法选择126例老年重症肺炎合并RF患者,随机分为对照组和观察组,每组63例.对照组给予盐酸氨溴索静脉滴注治疗,观察组给予盐酸氨溴索静脉滴注治疗联合BAL治疗,观察两组临床疗效,对比治疗前及治疗7 d后患者的呼吸功能、肺部症状及血清SP-D、sTREM-1水平,观察两组患者排痰量、机械通气时间、ICU住院时间和28 d治疗后的死亡率.结果观察组的临床总有效率为90.48%,显著高于对照组的76.19%(P<0.05);治疗7 d后,观察组患者动态顺应性(Cdyn)及氧合指数(PaO_(2)/FiO_(2))较治疗前显著提高(P<0.05),呼吸做功(WOB)较治疗前显著降低(P<0.05),对照组的上述指标较治疗前显著提高(P<0.05),两组患者的MLIS量表评分、CPIS量表评分较治疗前显著降低(P<0.05),两组患者的血清SP-D、sTREM-1水平较治疗前显著降低(P<0.05),以上指标两组间比较差异具有统计学意义(P<0.05);观察组的排痰量显著多于对照组(P<0.05),机械通气时间、ICU住院时间显著短于对照组(P<0.05),组间28 d死亡率比较差异无统计学意义(P>0.05).结论老年重症肺炎合并RF患者应用BAL联合盐酸氨溴索治疗疗效显著,能明显提高其呼吸功能,改善其肺部症状,并能下调患者血清SP-D、sTREM-1水平,明显促进患者排痰,缩短其机械通气时间和ICU住院时间.

Objective To explore the clinical efficacy of fiberoptic bronchoalveolar lavage(BAL)combined with intravenous drip of ambroxol hydrochloride in the treatment of elderly severe pneumonia with respiratory failure(RF).MethodA total of 126 elderly patients with severe pneumonia and RF were selected and randomly divided into control group and observation group,with 63 cases in each group.Control group was treated with intravenous drip of ambroxol hydrochloride,and observation group was given intravenous drip of ambroxol hydrochloride combined with BAL treatment.The clinical efficacy of the two groups was observed,and the respiratory function,pulmonary symptoms and levels of serum SP-D and sTREM-1 were compared before treatment and after 7 d treatment.The sputum output,mechanical ventilation time,ICU stay and mortality rate after 28 d treatment were observed in the two groups.ResultsThe total clinical effective rate in observation group was significantly higher than that in control group(90.48%vs 76.19%)(P<0.05).After 7 d trea-tment,the ventilator parameters of Cdyn and PaO_(2)/FiO_(2) in observation group were significantly higher than those before treatment(P<0.05)while the WOB was significantly lower than that before treatment(P<0.05),and the above indicators in control group were significantly higher than those before treatment(P<0.05).The scores of MLIS scale and CPIS scale in the two groups were significantly lower than those before treatment(P<0.05),and the levels of serum SP-D and sTREM-1 in the two groups were significantly lower than those before treatment(P<0.05),and there were statistically significant differences in the above indicators between the two groups(P<0.05).The sputum output in observation group was significantly more than that in control group(P<0.05),and the mechanical ventilation time and ICU stay were significantly shorter than those in control group(P<0.05),and there was no significant difference in the 28 d mortality rate between the two groups(P>0.05).ConclusionBAL combined with intravenous drip of ambroxol hydrochloride for elderly patients with severe pneumonia and RF has a significant efficacy,and can significantly enhance the respiratory function,improve the lung symptoms,and play a role in reducing serum SP-D and sTREM-1 levels.And it can significantly promote the sputum excretion,and shorten the mechanical ventilation time and ICU stay.