纤维支气管镜吸痰联合肺泡灌洗在呼吸机相关性肺炎中的应用价值研究

Study on application value of bronchoscopic sputum aspiration combined with alveolar lavage in ventilator-associated pneumonia

目的探讨纤维支气管镜吸痰联合肺泡灌洗在呼吸机相关性肺炎(VAP)治疗中的应用价值。方法70例VAP患者,采用随机数字表法分成对照组与试验组,各35例。对照组患者给予常规治疗,试验组患者在对照组基础上给予纤维支气管镜吸痰联合肺泡灌洗治疗。比较两组患者治疗效果及治疗前后临床肺部感染评分量表(CPIS)评分、血清炎症因子[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)、降钙素原(PCT)]、呼吸力学指标[气道峰压(PIP)、气道阻力(RAW)]、动脉血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))、氧合指数(OI)、血乳酸]。结果治疗前,两组患者CPIS评分比较差异无统计学意义(P>0.05);治疗后,两组患者的CPIS评分均低于本组治疗前,且试验组患者CPIS评分(3.46±1.20)分低于对照组的(4.46±1.40)分,差异有统计学意义(P<0.05)。试验组患者治疗总有效率80.00%高于对照组的54.29%,差异有统计学意义(P<0.05)。治疗前,两组患者IL-6、IL-8、PCT、CRP比较,差异无统计学意义(P>0.05);治疗后,两组患者IL-6、IL-8、PCT、CRP均低于本组治疗前,且试验组患者IL-6(7.25±1.11)ng/L、IL-8(1.08±0.31)ng/L、PCT(0.20±0.10)ng/ml、CRP(8.16±2.07)mg/L均低于对照组的(9.97±2.71)ng/L、(1.29±0.38)ng/L、(0.38±0.19)ng/ml、(18.16±3.03)mg/L,差异有统计学意义(P<0.05)。治疗前,两组患者PIP、RAW比较,差异无统计学意义(P>0.05);治疗后,两组患者PIP、RAW均低于本组治疗前,且试验组患者PIP(14.63±3.15)cm H_(2)O(1 cm H_(2)O=0.098 kPa)、RAW(7.54±1.58)cm H_(2)O/(L·s)均低于对照组的(23.91±3.14)cm H_(2)O、(11.49±1.65)cm H_(2)O/(L·s),差异有统计学意义(P<0.05)。治疗前,两组PaO_(2)、PaCO_(2)、SaO_(2)、血乳酸、OI比较,差异无统计学意义(P>0.05);治疗后,两组PaO_(2)、SaO_(2)、OI均显著高于本组治疗前,PaCO_(2)、血乳酸均显著低于本组治疗前,且试验组患者PaO_(2)(81.73±11.71)mm Hg(1 mm Hg=0.133 kPa)、SaO_(2)(95.89±3.58)%、OI(357.00±34.91)mm Hg均显著高于对照组的(74.84±10.14)mm Hg、(90.40±4.65)%、(303.71±24.95)mm Hg,PaCO_(2)(45.60±4.26)mm Hg、血乳酸(1.75±0.55)mmol/L均显著低于对照组的(49.57±5.71)mm Hg、(2.07±0.52)mmol/L,差异有统计学意义(P<0.05)。结论纤维支气管镜吸痰联合肺泡灌洗在VAP治疗中的应用效果较好。

Objective To discuss the application value of bronchoscopic sputum aspiration combined with alveolar lavage in ventilator-associated pneumonia(VAP).Methods A total of 70 cases of VAP patients were randomly divided into control group and experimental group,with 35 patients in each group.The control group received conventional treatment,and the experimental group received bronchoscopic sputum aspiration combined with alveolar lavage on the basis of the control group.Both groups were compared in terms of therapeutic effect,clinical pulmonary infection scale(CPIS)score,serum inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),C-reactive protein(CRP),procalcitonin(PCT)],respiratory mechanics indexes[peak inspiratory pressure(PIP),airway resistance(RAW)],arterial blood gas analysis indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2)),oxygenation index(OI),blood lactate]before and after treatment.Results Before treatment,there was no statistically significant difference in CPIS score between the two groups(P>0.05).After treatment,CPIS score in both groups was lower than that before treatment in this group,and CPIS score of(3.46±1.20)points in the experimental group was lower than that of(4.46±1.40)points in the control group.The differences were statistically significant(P<0.05).The total effective rate of 80.00%in the experimental group was higher than that of 54.29%in the control group,and the difference was statistically significant(P<0.05).Before treatment,there were no statistically significant differences in IL-6,IL-8,PCT and CRP between the two groups(P>0.05).After treatment,IL-6,IL-8,PCT and CRP in both groups were lower than those before treatment in this group;the experimental group had IL-6 of(7.25±1.11)ng/L,IL-8 of(1.08±0.31)ng/L,PCT of(0.20±0.10)ng/ml and CRP of(8.16±2.07)mg/L,which were lower than those of(9.97±2.71)ng/L,(1.29±0.38)ng/L,(0.38±0.19)ng/ml and(18.16±3.03)mg/L in the control group;the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in PIP and RAW between the two groups(P>0.05).After treatment,PIP and RAW in both groups were lower than those before treatment in this group;PIP of(14.63±3.15)cm H_(2)O(1 cm H_(2)O=0.098 kPa)and RAW of(7.54±1.58)cm H_(2)O/(L·s)in the experimental group were lower than those of(23.91±3.14)cm H_(2)O and(11.49±1.65)cm H_(2)O/(L·s)in the control group;the differences were statistically significant(P<0.05).Before treatment,there were no statistically significant differences in PaO_(2),PaCO_(2),SaO_(2),blood lactic acid and OI between the two groups(P>0.05).After treatment,PaO_(2),SaO_(2)and OI in both groups were significantly higher than those before treatment in this group,while PaCO_(2)and blood lactic acid were significantly lower than those before treatment in this group;the experimental group had PaO_(2)of(81.73±11.71)mm Hg(1 mm Hg=0.133 kPa),SaO_(2)of(95.89±3.58)%and OI of(357.00±34.91)mm Hg,which were significantly higher than those of(74.84±10.14)mm Hg,(90.40±4.65)%and(303.71±24.95)mm Hg in the control group;PaCO_(2)of(45.60±4.26)mm Hg and blood lactic acid of(1.75±0.55)mmol/L in the experimental group were significantly lower than those of(49.57±5.71)mm Hg and(2.07±0.52)mmol/L in the control group;the differences were statistically significant(P<0.05).Conclusion Bronchoscopic sputum aspiration combined with alveolar lavage is effective in the treatment of VAP.