纤维支气管镜灌洗对重症肺炎合并呼吸衰竭呼吸力学指标的影响

Effects of Fibrobronchoscopic Bronchoalveolar Lavage on Respiratory Mechanics with Severe Pneumonia Complicated with Respiratory Failure

目的研究纤维支气管镜灌洗(BAL)对重症肺炎(SP)合并呼吸衰竭患者呼吸力学指标的影响。方法回顾性分析本院2017年3月至2019年4月诊治的85例SP合并呼吸衰竭患者的临床资料,根据患者治疗方法将其分为对照组(40例,常规综合治疗)与研究组(45例,常规综合治疗基础上联合BAL治疗)。比较两组患者治疗前后血气参数、血清炎性因子、呼吸力学指标水平的变化,并评估疗效和不良反应。结果治疗前两组患者动态顺应性(Cdyn)、呼吸做功(WOB)以及吸气阻力(RAW)、动脉血氧和二氧化碳分压(PaO_(2),PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))、C反应蛋白(CRP)、降钙素原(PCT)、可溶性髓系细胞触发受体-1(sTREM-1)水平差异均无统计学意义(P均>0.05),治疗后研究组患者Cdyn、WOB和RAW水平、PaCO_(2)、CRP、PCT、sTREM-1水平均低于对照组,PaO_(2)和PaO_(2)/FiO_(2)水平均高于对照组(P均<0.05);研究组治疗总有效率高于对照组(P<0.05);两组患者均无严重不良反应。结论BAL治疗SP合并呼吸衰竭患者,可改善其呼吸力学指标,并减轻炎性反应。

Objective To study the effects of fibrobronchoscopic bronchoalveolar lavage(BAL)on respiratory mechanics in patients with severe pneumonia(SP)complicated with respiratory failure.Methods The clinical data of 85 patients with SP complicated with respiratory failure treated in our hospital from March 2017 to April 2019 were analyzed retrospectively.According to treatment methods,the patients were included in control group(40 cases,conventional comprehensive treatment)and study group(45 cases,BAL on the basis of conventional comprehensive treatment).The levels of blood gas parameters,serum inflammatory factors and respiratory mechanics indexes before and after treatment were compared between the two groups.The curative effect and adverse reactions were evaluated.Results Before treatment,no significant differences were found between the 2 groups in dynamic compliance(Cdyn),work of breathing(WOB)and airway resistance(RAW),partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2)),C-reactive protein(CRP),procalcitonin(PCT)and soluble triggering receptor expressed on myeloid cell-1(sTREM-1)levels(P all>0.05).After treatment,Cdyn,WOB and RAW levels,PaCO_(2),CRP,PCT,sTREM-1 levels were significantly lower in the study group than in the control group,while PaO_(2) and PaO_(2)/FiO_(2) were significantly higher than the control group(P all<0.05).The total response rate in the study group was significantly higher than that in the control group(P<0.05).No serious adverse reactions were found in either group.Conclusion Using BAL to treat patients with SP complicated with respiratory failure can significantly improve respiratory mechanical indexes and alleviate inflammatory response.