纤支镜肺泡灌洗术配合抗生素降阶梯疗法对重症肺炎患者呼吸力学及炎症指标的影响

Effects of Bronchofiberscope Alveolar Lavage Combined with Antibiotic Step-down Therapy on Respiratory Mechanics and Inflammatory Indexes in Patients with Severe Pneumonia

目的:探讨纤支镜肺泡灌洗术配合抗生素降阶梯疗法对重症肺炎患者呼吸力学及炎症指标的影响。方法:选择某院重症监护室从2019年11月-2020年11月收治的90例重症肺炎患者,随机数字表法分对照组和观察组各45例,对照组采用抗生素升级治疗,观察组在对照组基础上采用纤支镜肺泡灌洗术配合抗生素降阶梯疗法治疗,连续治疗14d。比较两组呼吸力学参数[气道峰压(PIP)、动态顺应性(Cdyn)和呼吸做功(WOB)]、炎症因子[白细胞介素(IL)-6、白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α、转化生长因子(TGF)-β]。结果:两组治疗前PIP、Cdyn、WOB表达无统计学差异(P>0.05),治疗后观察组PIP、WOB表达低于对照组(P<0.05),Cdyn表达显著高于对照组(P<0.05);两组治疗前IL-6、IL-8、TNF-α、TGF-β表达无统计学差异(P>0.05),两组治疗后IL-6、IL-8、TNF-α表达显著降低(P<0.05),且观察组显著低于对照组(P<0.05),两组TGF-β表达显著提高(P<0.05),且观察组显著高于对照组(P<0.05)。结论:纤支镜肺泡灌洗术配合抗生素降阶梯疗法可有效恢复重症肺炎患者呼吸功能,这可能和减轻炎症反应有关。

Objective:To investigate the effect of bronchofiberscope alveolar lavage combined with antibiotic step-down therapy on respiratory mechanics and inflammatory indexes in patients with severe pneumonia.Methods:90 patients with severe pneumonia treated in the intensive care unit of a hospital from November 2019 to November 2020 were selected and randomly divided into the control group(45 cases,upgraded treatment with antibiotics)and the observation group(45 cases,bronchofiberscope alveolar lavage combined with antibiotic step-down therapy on the basis of the control group,and the two groups were continuously treated for 14 days.The respiratory mechanical parameters[peak airway pressure(PIP),dynamic compliance(Cdyn)and respiratory work(WOB)],inflammatory factors[interleukin(IL)-6,interleukin(IL)-8,tumor necrosis factor(TNF)-α,transforming growth factor(TGF)-β]were compared between the two groups.Results:There was no significant difference in the expression of PIP,Cdyn and WOB between the two groups before treatment(P>0.05),after treatment,the expression of PIP and WOB in the observation group was lower than that in the control group(P<0.05),and the expression of Cdyn was significantly higher than that in the control group(P<0.05).There was no significant difference in expression of IL-6,IL-8,TNF-α,and TGF-βbetween the two groups before treatment(P>0.05),the expression of IL-6,IL-8 and TNF-αin the two groups after treatment was significantly decreased,and the observation group was significantly lower than the control group(P<0.05),the expression of TGF-βin the two groups after treatment was significantly increased,and the observation group was significantly higher than the control group(P<0.05).Conclusion:Bronchofiberscope alveolar lavage combined with antibiotic step-down therapy can effectively restore respiratory function in patients with severe pneumonia,which may be related to reducing inflammatory response.