纤维支气管镜吸痰联合肺泡灌洗治疗重症肺炎并发呼吸衰竭的效果

Effect of sputum suction combined with bronchoalveolar lavage by fiberoptic bronchoscopy on severe pneumonia complicated by respiratory failure

目的研究纤维支气管镜吸痰联合肺泡灌洗治疗重症肺炎并发呼吸衰竭的临床效果。方法抽取2019年8月至2021年12月南阳市第二人民医院收治的重症肺炎并发呼吸衰竭的患者72例,按照随机排列法分为对照组和研究组,每组36例。对照组给予常规治疗,研究组给予纤维支气管镜吸痰联合肺泡灌洗治疗。治疗2周后评价总有效率,统计发热时间、机械通气时间、气管分泌物清除时间、住院时间,比较两组干预前后的血气指标[血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))]、炎性指标[C反应蛋白(CRP)、降钙素原(PCT)]。结果研究组总有效率(91.67%,33/36)高于对照组(72.22%,26/36),P<0.05。研究组发热时间、机械通气时间、气管分泌物清除时间、住院时间均短于对照组(t=4.33、4.54、4.23、2.87,P均<0.05)。干预前,两组血气指标、炎性指标水平比较,差异未见统计学意义(P>0.05)。干预后,研究组PaO_(2)、CRP、PCT水平均低于对照组(t=8.56、8.15、13.76,P均<0.05),研究组PaCO_(2)、SaO_(2)水平均高于对照组(t=4.95、4.38,P均<0.05)。结论纤维支气管镜吸痰联合肺泡灌洗治疗重症肺炎并发呼吸衰竭的效果更理想,可缩短机械通气时间以及气道分泌物清除时间,改善血气指标,减轻炎性反应,患者住院时间明显缩短。

Objective To study the clinical effect of sputum suction combined with bronchoalveolar lavage by fiberoptic bronchoscopy on severe pneumonia patients with respiratory failure.Methods A total of 72 patients with severe pneumonia complicated by respiratory failure admitted to Nanyang Second People’s Hospital from August 2019 to December 2021 were selected,and the patients were divided into control group and study group according to randomized arrangement method,with 36 cases in each group.The control group was treated by conventional treatment,and the study group was treated by sputum suction combined with alveolar lavage by fiberoptic bronchoscopy.The total effective rate was evaluated after 2 weeks of treatment;the fever time,mechanical ventilation time,trachea secretion clearance time and hospital stay were counted.The blood gas indicators including blood oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),blood oxygen saturation(SaO_(2)),the inflammatory indicators including C-reactive protein(CRP)and procalcitonin(PCT)before and after intervention were compared between the two groups.Results The total effective rate of the study group(91.67%,33/36)was higher than that of the control group(72.22%,26/36),P<0.05.The duration of fever,mechanical ventilation,clearance of trachea secretions,and hospital stay in the study group were shorter than those in the control group(t=4.33,4.54,4.23,2.87;all P<0.05).Before the intervention,there was no significant difference in the levels of blood gas indexes and inflammatory indicators between the two groups(P>0.05).After the intervention,the levels of PaO_(2),CRP,and PCT in the study group were lower than those in the control group(t=8.56,8.15,13.76;all P<0.05);the levels of PaCO_(2) and SaO_(2) in the study group were higher than those in the control group(t=4.95,4.38;all P<0.05).Conclusions Sputum suction combined with alveolar lavage by fiberoptic bronchoscopy is more effective in the treatment of severe pneumonia complicated by respiratory failure.It can shorten the time of mechanical ventilation and clearance of trachea secretions,improve blood gas indicators,eliminate inflammatory reactions,and significantly shorten the hospital stay.