纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎患者血清降钙素原、CRP的水平影响

Effect of bronchofiberoscopic alveolar lavage on serum procalcitonin and CRP in patients with severe ventilator-associated pneumonia

目的:探究纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎(VAP)患者血清降钙素原(PCT)、C反应蛋白(CRP)影响。方法:选我院2017年10月至2021年4月期间62例重症VAP患者为研究对象,以随机数字表法分为对照组、观察组,各31例,分别接受常规肺泡灌洗、纤维支气管镜肺泡灌洗,比较两组康复用时(感染控制时间、退热时间、机械通气时间)、治疗前后血氧指标、肺功能指标及PCT、CRP水平变化。结果:观察组感染控制时间、退热时间、机械通气时间均较对照组短(P<0.05);治疗前两组血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))水平相近(P>0.05);治疗后观察组PaO_(2)水平较对照组高,PaCO_(2)水平较对照组低(P<0.05);治疗前两组最大呼气流量(PEF)、内源性呼吸末正压(PEEPi)水平相近(P>0.05);治疗后观察组PEF水平较对照组高,PEEPi水平较对照组低(P<0.05);治疗前两组白细胞介素-6(IL-6)、肿瘤细胞坏死因子-α(TNF-α)、PCT、CRP水平相近(P>0.05);治疗后观察组IL-6、TNF-α、PCT、CRP水平较对照组低(P<0.05)。结论:对重症VAP患者应用纤维支气管镜肺泡灌洗治疗,可缩短康复用时,改善患者血氧水平及肺功能,降低炎症反应程度。

Objective:To investigate the effects of bronchofiberoscopic alveolar lavage on serum procalcitonin(PCT)and C-reactive protein(CRP)in patients with severe ventilator associated pneumonia(VAP).Methods:A total of 62 patients with severe VAP in our hospital from October 2017 to April 2021 were selected as the research subjects.The patients were divided into control group and observation group with 31 patients in each group by random number table method.The blood oxygen indexes,lung function indexes,PCT and CRP levels of the two groups were compared before and after treatment.Results:The infection control time,antipyretic time and mechanical ventilation time in the observation group were shorter than those in the control group(P<0.05);Before treatment,the levels of oxygen partial pressure(PaO_(2))and carbon dioxide partial pressure(PaCO_(2))in the two groups were similar(P>0.05).After treatment,the level of PaO_(2) in observation group was higher than that in control group,and the level of PaCO_(2) was lower than that in control group(P<0.05).Before treatment,the levels of maximum expiratory flow(PEF)and endogenous positive end-respiratory pressure(PEEPI)in the two groups were similar(P>0.05).After treatment,the level of PEF in observation group was higher than that in control group,and the level of PEEPI was lower than that in control group(P<0.05).Before treatment,the levels of interleukin-6(IL-6),tumor cell necrosis factor-α(TNF-α),PCT and CRP in the two groups were similar(P>0.05).After treatment,the levels of IL-6,TNF-α,PCT and CRP in observation group were lower than those in control group(P<0.05).Conclusion:The application of fiberoptic bronchoscopic alveolar lavage in patients with severe VAP can shorten the time of rehabilitation,improve the blood oxygen level and pulmonary function,and reduce the degree of inflammatory reaction.