盐酸氨溴索联合纤维支气管镜肺泡灌洗治疗重症肺炎患者的疗效

The curative effect of ambroxol hydrochloride combined with fiberoptic bronchoscope alveolar lavage in the treatment of patients with severe pneumonia

目的探讨盐酸氨溴索联合纤维支气管镜肺泡灌洗方案治疗重症肺炎患者的疗效,为临床治疗重症肺炎提供现实依据。方法选取2020年1月—2021年7月我院呼吸科收治的282例重症肺炎患者为研究对象,按照随机数表法分为观察组和对照组,每组141例。对照组采用盐酸氨溴索治疗,观察组采用盐酸氨溴索联合纤维支气管镜肺泡灌洗治疗。比较两组患者临床疗效、呼吸[呼吸机带机时间、平均住院时间、治疗1周后急性生理与慢性健康评分(APACHE-Ⅱ)]、炎症[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)水平]等指标水平、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、多器官脏器衰竭发生率以及死亡率。结果治疗后,观察组总有效率(78.72%)显著高于对照组(51.06%)(P<0.05);治疗后,两组外周血清CRP、IL-6、IL-8、APTT、FIB水平均低于治疗前,且观察组低于对照组(P<0.05);观察组呼吸机带机时间、平均住院时间、治疗1周APACHE-Ⅱ均低于对照组,差异均有统计学意义(P<0.05);观察组多器官脏器衰竭发生率(10.64%)低于对照组(24.11%);观察组死亡率(8.51%)明显低于对照组(18.44%)(P<0.05)。以盐酸氨溴索、盐酸氨溴索联合纤维支气管镜肺泡灌洗方案治疗重症肺炎患者,灵敏度分别为80.6%、86.9%,特异度分别为78.3%、87.4%,AUC分别为0.785、0.867,约登指数为0.589、0.743。BP神经网络模型以盐酸氨溴索、纤维支气管镜肺泡灌洗方案作为输入,临床疗效结果作为输出,经过模型优化,隐含层节点数为3时,模型AUC最大为0.876(95%CI:0.796~0.922),准确度为93.68%,具有良好的一致性。结论盐酸氨溴索联合纤维支气管镜肺泡灌洗治疗重症肺炎效果显著,且安全可靠,临床上可推广应用。

Objective To explore the efficacy of ambroxol hydrochloride combined with fiberoptic bronchoscopy alveolar lavage in the treatment of patients with severe pneumonia,and provide a realistic basis for clinical treatment of severe pneumonia.Methods 282 patients with severe pneumonia admitted to our hospital’s respiratory department from January 2020 to July 2021 were selected as the research objects.According to the random number table method,they were divided into observation group and control group,each with 141 cases.The control group was treated with ambroxol hydrochloride,and the observation group was treated with ambroxol hydrochloride combined with fiberoptic bronchoscopic alveolar lavage.The clinical efficacy,time spent on ventilator,average length of hospital stay,acute physiology and chronic health score(APACHE-Ⅱ)after 1 week of treatment were compared between the two groups of patients.Levels of IL-8(IL-8),C-reactive protein(CRP),activated partial thromboplastin time(APTT),fibrinogen(FIB),incidence of multiple organ failure and mortality were observed.Results After treatment,the response efficiency of the observation group and the control group was 78.72%and 51.06%.After treatment,the peripheral serum CRP,IL-6,IL-8,APTT,and FIB levels of the observation group were all lower than those in the control group.The ventilator belt time,mean hospital stay,APACHE of 1 week of treatment of the observation group were lower than those in the control group.The difference was statistically significant(P<0.05).The incidence of multiple organ failure in the observation group was 10.64%lower than 24.11%in the control group.The mortality rate in the observation group(8.51%)was significantly lower than that in the control group(18.44%).For patients with severe pneumonia with ambroxol hydrochloride,fiber bronchoscopic alveolar lavage regimen,and ambroxol hydrochloride combined with fibrobronchoscope,the sensitivity were 80.6%and 86.9%,the specificity were 78.3%and 87.4%,the AUC was 0.785,0.867,and Yoden index was 0.589 and 0.743,respectively.The BP neural network model take ambroxol hydrochloride and fiber bronchoscope alveolar lavage scheme as input,and the clinical efficacy results as output.After the model optimization and the number of hidden layer nodes was 3,the maximum AUC of the model was 0.876(95%CI:0.796~0.922),and the accuracy is 93.68%,with good consistency.Conclusion Ambroxol hydrochloride combined with fiberoptic bronchoscope alveolar lavage is effective in the treatment of severe pneumonia,and can be used clinically.