振动排痰联合纤维支气管镜肺灌洗在重症肺炎患者机械通气治疗中的效果观察

Observation on the effect of vibratory sputum ejection combined with bronchoalveolar lavage in mechanical ventilation for patients with severe pneumonia

目的观察振动排痰联合纤维支气管镜肺灌洗应用于重症肺炎机械通气中的效果。方法106例入重症加强护理病房(ICU)接受机械通气治疗的重症肺炎患者,采用随机抽签法分为对照组和试验组,每组53例。对照组患者给予纤维支气管镜肺灌洗治疗,试验组患者在对照组基础上配合振动排痰治疗。比较两组患者的治疗效果、生命体征指标、呼吸以及血气指标[氧合指数(PaO_(2)/FiO_(2))、呼吸功(WOB)、肺动态顺应性(Cdyn)、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))]。结果试验组治疗总有效率96.23%高于对照组的84.91%,差异具有统计学意义(P<0.05)。两组患者的呼吸频率、心率、平均动脉压对比差异均无统计学意义(P>0.05)。试验组PaO_(2)/FiO_(2)(273.44±17.33)mm Hg(1 mm Hg=0.133 kPa)、Cdyn(37.98±4.32)ml/cm H_(2)O(1 cm H_(2)O=0.098 kPa)、PaO_(2)(95.44±10.36)mm Hg均高于对照组的(234.65±18.48)mm Hg、(31.12±4.83)ml/cm H_(2)O、(81.73±10.82)mm Hg,WOB(0.71±0.12)J/L、PaCO_(2)(43.21±7.72)mm Hg均低于对照组的(1.02±0.11)J/L、(48.96±8.65)mm Hg,差异具有统计学意义(P<0.05)。结论重症肺炎在机械通气期间联合使用振动排痰和纤维支气管镜肺灌洗的效果显著,可改善患者的呼吸功能及血气指标。

Objective To observe the effect of vibratory sputum ejection combined with bronchoalveolar lavage in mechanical ventilation for patients with severe pneumonia.Methods A total of 106 patients with severe pneumonia admitted to the intensive care unit(ICU)for mechanical ventilation were randomly divided into control group and experimental group,with 53 cases in each group.Patients in the control group were treated with bronchoalveolar lavage,and patients in the experimental group were treated with vibratory sputum ejection on the basis of the control group.Both groups were compared in terms of therapeutic effect,vital sign parameters,respiratory and blood gas indexes[oxygenation index(PaO_(2)/FiO_(2)),work of breathing(WOB),pulmonary dynamic compliance(Cdyn),arterial partial pressure of blood oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))].Results The total effective rate 96.23% of the experimental group was higher than 84.91% of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in respiratory rate,heart rate and mean arterial pressure between the two groups(P>0.05).The PaO_(2)/FiO_(2)(273.44±17.33)mm Hg(1 mm Hg=0.133 kPa),Cdyn(37.98±4.32)ml/cm H_(2)O(1 cm H_(2)O=0.098 kPa),PaO_(2)(95.44±10.36)mm Hg of the experimental group were higher than(234.65±18.48)mm Hg,(31.12±4.83)ml/cm H_(2)O,(81.73±10.82)mm Hg of the control group;the WOB(0.71±0.12)J/L,PaCO_(2)(43.21±7.72)mm Hg of the experimental group were lower than(1.02±0.11)J/L,(48.96±8.65)mm Hg of the control group;all the differences were statistically significant(P<0.05).Conclusion Vibratory sputum ejection combined with bronchoalveolar lavage has significant effect in the treatment of severe pneumonia during mechanical ventilation,and can improve the respiratory function and blood gas indicators.