支气管肺泡灌洗联合局部应用敏感抗生素对COPD合并Ⅱ型呼吸衰竭患者血气分析及炎症因子的影响

Effects of Bronchoalveolar Lavage Combined with Local Application of Sensitive Antibiotics on Blood Gas Analysis and Inflammatory Factors in Patients with COPD Complicated with TypeⅡRespiratory Failure

目的:研究支气管肺泡灌洗(BAL)联合局部应用敏感抗生素对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者血气分析指标、炎症因子水平及无创通气时间、肺部感染控制时间,呼吸重症监护病房(RICU)停留时间和住院天数的影响。方法:收集2021年6月-2022年3月在景德镇市中医医院呼吸科住院的COPD合并Ⅱ型呼吸衰竭的100例患者作为研究对象。按照随机数字表法将其分为对照组和治疗组,各50例。两组均予低流量给氧、营养支持,抗炎化痰平喘、纠正酸碱失衡、无创呼吸机辅助通气、支气管肺泡灌洗等对症治疗,治疗组在上述治疗基础上局部运用敏感抗生素30 mL,每4天1次。比较两组临床指标、治疗前后血气分析指标及炎症因子水平。结果:治疗前,两组血气分析指标、炎症因子水平比较,差异均无统计学意义(P>0.05);治疗后,两组动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))、pH值均高于治疗前,动脉血二氧化碳分压(PaCO_(2))、呼吸频率(RR)及白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞计数(WBC)水平均低于治疗前(P<0.05),且治疗组改善均优于对照组(P<0.01)。治疗组无创通气时间、肺部感染控制时间、RICU停留时间及天数均明显短于对照组(P<0.05)。结论:BAL联合局部应用敏感抗生素能有效改善COPD合并Ⅱ型呼吸衰竭患者血气分析结果,降低炎症因子水平,改善通气情况,缩短无创通气时间、肺部感染控制时间、RICU停留时间及住院天数,临床疗效确切,值得推广。

Objective:To investigate the effects of bronchoalveolar lavage(BAL)combined with local application of sensitive antibiotics on blood gas analysis indexes,inflammatory factor levels,non-invasive ventilation time,lung infection control time,respiratory intensive care unit(RICU)residence time and hospital days in patients with chronic obstructive pulmonary disease(COPD)complicated with typeⅡrespiratory failure.Method:A total of 100 patients with COPD complicated with typeⅡrespiratory failure hospitalized in the Respiratory Department of Jingdezhen Hospital of Traditional Chinese Medicine from June 2021 to March 2022 were selected as the research objects.According to the random number table method,they were divided into the control group and the treatment group,with 50 patients in each group.Two groups were given low flow oxygen,nutritional support,anti-inflammatory phlegm,asthma,acid-base imbalance correction,non-invasive ventilator-assisted ventilation,bronchoalveolar lavage and other symptomatic treatment,the treatment group on the basis of the above treatment,sensitive antibiotics were locally administered 30 mL once for 4 d.The clinical indexes,blood gas analysis indexes and inflammatory factor levels before and after treatment of two groups were compared.Result:Before treatment,there were no significant differences in blood gas analysis indexes and inflammatory factors between two groups(P>0.05);after treatment,the arterial partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))and pH value in two groups were higher than those before treatment,the arterial partial pressure of carbon dioxide(PaCO_(2)),respiratory rate(RR),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C reactive protein(CRP),white blood cell count(WBC)were lower than those before treatment(P<0.05),and the improvements of the treatment group were better than those of the control group(P<0.01).The non-invasive ventilation time,lung infection control time,RICU residence time and hospital days in the treatment group were significantly shorter than those in the control group(P<0.05).Conclusion:BAL combined with local application of sensitive antibiotics can effectively improve the results of blood gas analysis inpatients with COPD complicated with typeⅡrespiratory failure,reduce inflammatory factors levels,improve pulmonary ventilation,shorten non-invasive ventilation time,lung infection control time,RICU residence time and hospital days,the clinical effect is definite,and it is worthy of promotion.