经鼻高流量氧疗联合纤维支气管镜下肺泡灌洗治疗脑卒中患者合并肺不张的疗效

Efficacy of high-flow nasal cannula oxygen therapy combined with alveolar lavage under fiberoptic bronchoscope in the treatment of stroke patients complicated with atelectasis

目的 观察经鼻高流量氧疗(HFNC)联合纤维支气管镜下肺泡灌洗治疗脑卒中患者合并肺不张的疗效。方法 脑卒中合并肺不张患者84例均分为治疗(A)组和对照(C)组,两组均给予常规药物治疗和HFNC,A组行第1、3、5天纤维支气管镜下肺泡灌洗。比较两组临床疗效、动脉血气指标、炎症指标、气管插管率、住院时间及并发症发生情况。结果 A组临床总有效率高于C组[92.86%(39/42) vs.73.81%(31/42)](P<0.05)。A组第1、3、5天肺泡灌洗后的动脉血气指标和炎症指标改善均优于C组(P<0.05),随着肺泡灌洗次数的增加,动脉血气指标和炎症指标改善越明显(P<0.05)。与C组比较,A组气管插管率低,住院时间短(P<0.05)。两组并发症发生率相仿(P>0.05)。结论 HFNC联合纤维支气管镜下肺泡灌洗能促进脑卒中合并肺不张患者的肺复张,改善肺通气功能,减轻炎症反应,降低气管插管率,缩短住院时间。

Objective To observe the efficacy of high-flow nasal cannula oxygen therapy(HFNC)combined with alveolar lavage under fiberoptic bronchoscope in the treatment of stroke patients complicated with atelectasis.Methods A total of 84patients with stroke complicated with atelectasis were divided into two groups of A and C with 42cases each.Both groups were given conventional drug therapy and HFNC.Group A received additional alveolar lavage under fiberoptic bronchoscope on the 1st,3rd and 5th day.Clinical efficacy,arterial blood gas indicators,inflammatory factor indicators,tracheal intubation rate,hospital stay and incidence of complications were compared between the two groups.Results The total clinical effectiveness rate of group A was higher than that of group C[92.86%(39/42)vs.73.81%(31/42)](P<0.05).After alveolar lavage on the 1st,3rd and 5th day,the improvements in arterial blood gas indicators,inflammatory factor indicators were better in group A than those in group C(P<0.05),which were more obvious as increased times of alveolar lavage(P<0.05).Compared with group C,tracheal intubation rate in group A was lower and hospital stay was shorter(P<0.05).The incidence of complications of two groups was similar(P>0.05).Conclusion In stroke patients with atelectasis,HFNC combined with alveolar lavage under fiberoptic bronchoscope can promote lung reexpansion,improve lung ventilation function,alleviate inflammation,reduce tracheal intubation rate,and shorten hospital stay.