电子支气管镜支气管肺泡灌洗联合盐酸氨溴索治疗脑卒中后重症肺炎的临床疗效

Electronic bronchoscope alveolar lavage combined with ambroxol hydrochloride for the patients with severe pneumonia after stroke

目的探讨不同途径电子支气管镜支气管肺泡灌洗(BAL)联合盐酸氨溴索治疗对脑卒中后重症肺炎患者临床疗效、炎症因子及动脉血气指标的影响。方法选择2020年1月至2021年8月南充市中心医院接诊的86例脑卒中后重症肺炎患者进行研究。采用随机数字表法将患者分为观察组与对照组,各43例。两组均进行电子支气管镜下BAL:对照组通过三通接口置入电子支气管镜BAL联合盐酸氨溴索治疗,观察组则行间断断开机械通气,吸氧下迅速短时间导管内操作吸痰、灌洗联合盐酸氨溴索治疗。比较两组患者治疗1周后临床疗效、治疗前后炎症因子及动脉血气指标。结果观察组患者总有效率为76.74%,对照组为81.40%,差异无统计学意义(P>0.05)。在治疗1周后,两组患者降钙素原、C反应蛋白及白细胞介素6水平均低于治疗前(P<0.01),但组间差异无统计学意义(P>0.05)。治疗1周后,两组氧分压均明显升高、二氧化碳分压均明显下降(P<0.05),pH值无显著变化(P>0.05),且三项指标两组间比较差异无统计学意义(P>0.05)。结论间断断开机械通气,吸氧下迅速短时间电子支气管镜下吸痰、灌洗联合盐酸氨溴索治疗,与三通接口置入电子支气管镜BAL联合盐酸氨溴索治疗,对脑卒中后重症肺炎患者疗效相当,且均可缓解炎症反应,改善动脉血气指标。

Objective To explore the impacts of electronic bronchoscope alveolar lavage(BAL)combined with ambroxol hydrochloride on clinical efficacy,inflammatory factors and arterial blood gas indexes in the patients with severe pneumonia after stroke.Methods Eighty-six patients with severe post-stroke pneumonia admitted to Nanchong Central Hospital from January 2020 to August 2021 were selected and randomly divided into observation group and control group(n=43,each).The electronic BAL through the three-way inferface combined with ambroxol hydrochloride was conducted in control group,while the sputum suction and lavage combined with ambroxol hydrochloride were performed quickly under oxygen inhalation with intermittent mechanical ventilation in observation group.The clinical efficacy 1 week after treatment,the serum inflammatory factors and arterial blood gas indexes were compared before and after treatment.Results The total effective rate in observation group was similar to that in control group(76.74%vs 81.40%,P>0.05).After treatment for 1 week,the level of procalcitonin(PCT),C-reactive protein(CRP)and interleukin-6(IL-6)were statistically lower than those before treatment in two groups(P<0.01),but there were no significant differences between two groups(P>0.05).The oxygen partial pressure increased significantly,the carbon dioxide partial pressure decreased significantly(P<0.05),and pH value exhibited no significant change compared with those before treatment in two groups(P>0.05).There were no significant differences in the three indicators between two groups(P>0.05).Conclusion Under oxygen inhalation with intermittent disconnection of mechanical ventilation,rapid sputum suction and lavage using electronic bronchoscope combined with ambroxol hydrochloride,and electronic bronchoscope BAL through the three-way interface combined ambro×01 hydrochloride have the same curative effect.It can also alleviate inflammatory reaction and improve arterial blood gas indicators.