床旁纤维支气管镜辅助吸痰对重症下呼吸道感染患者肺部通气功能及血清炎症介质水平的影响

Effect of Bedside Bronchoscopy Assisted Sputum Aspiration on Pulmonary Ventilation Function and Serum Inflammatory Mediators in Patients with Severe Lower Respiratory Tract Infection

目的研究床旁纤维支气管镜(纤支镜)辅助吸痰对重症下呼吸道感染(LRTI)患者肺部通气功能及血清炎症介质水平的影响。方法选取2019年1月-2022年7月万载县人民医院重症医学科收治的70例重症LRTI患者,按照随机数字表法分为对照组(32例)和观察组(38例)。对照组给予常规治疗,观察组在其基础上应用床旁纤支镜辅助吸痰治疗,比较两组临床疗效、临床恢复情况(机械通气时间、ICU住院时间、肺啰音消失时间、抗菌药物使用时间)、肺部通气功能[吸氧溶度(FiO_(2))、气道峰压(Ppeak)、潮气量(VT)]、血气指标[血氧饱和度(SpO_(2))、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))]、血清炎症介质水平[C反应蛋白(CRP)、降钙素原(PCT)]。结果观察组治疗总有效率高于对照组(P<0.05);观察组机械通气时间、ICU住院时间、肺啰音消失时间、抗菌药物使用时间均短于对照组(P<0.05);观察组治疗后FiO_(2)、Ppeak低于对照组,VT高于对照组(P<0.05);观察组治疗后SpO_(2)、PaO_(2)高于对照组,PaCO_(2)低于对照组(P<0.05);观察组治疗后CRP、PCT低于对照组(P<0.05)。结论床旁纤支镜辅助吸痰可提高重症LRTI患者的临床疗效,缩短其临床恢复时间,同时改善患者的肺通气功能与血气指标,下调其血清炎症介质水平。

Objective To study the effects of bedside bronchoscopy assisted sputum aspiration on pulmonary ventilation function and serum inflammatory mediators in patients with severe lower respiratory tract infection.Methods A total of 70 patients with severe LRTI admitted to the Department of Critical Care Medicine of Wanzai County People's Hospital from January 2019 to July 2022 were selected and divided into control group(32 patients)and observation group(38 patients)according to the random number table method.The control group was given routine treatment,and the observation group was treated with bedside bronchoscopy assisted sputum aspiration on the basis of routine treatment.The clinical efficacy,clinical recovery(mechanical ventilation time,ICU hospitalization time,lung rale disappearance time,antibiotic use time),pulmonary ventilation function[oxygen solubility(FiO_(2)),airway peak pressure(Ppeak),tidal volume(VT)],blood gas index[oxygen saturation(SpO_(2)),oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2))],serum inflammatory mediators[C-reactive protein(CRP),procalcitonin(PCT)]were compared between the two groups.Results The total effective rate of treatment in the observation group was higher than that in the control group(P<0.05).The mechanical ventilation time,ICU hospitalization time,lung rale disappearance time and antibiotic use time in the observation group were shorter than those in the control group(P<0.05).After treatment,FiO_(2)and Ppeak in the observation group were lower than those in the control group,and VT was higher than that in the control group(P<0.05).After treatment,SpO_(2)and PaO_(2)in the observation group were higher than those in the control group,and PaCO_(2)was lower than that in the control group(P<0.05).After treatment,CRP and PCT in the observation group were lower than those in the control group(P<0.05).Conclusion Bedside bronchoscopy assisted sputum aspiration can improve the clinical efficacy of patients with severe LRTI,shorten their clinical recovery time,improve their pulmonary ventilation function and blood gas indexes,and down-regulate their serum inflammatory mediators.