盐酸氨溴索联合纤维支气管镜吸痰对老年重症肺炎患者临床疗效及血气分析指标的影响

Clinical efficacy of ambroxol hydrochloride combined with sputum suction by fiberoptic bronchoscope in elderly patients with severe pneumonia and its effect on blood gas analysis indexes

目的探讨盐酸氨溴索联合纤维支气管镜吸痰对老年重症肺炎患者临床疗效及血气分析指标的影响。方法选取空军军医大学第二附属医院2017年11月至2022年9月收治的122例老年重症肺炎患者。根据具体治疗方法分为观察组与对照组。对照组在基础治疗上叠加盐酸氨溴索治疗,静脉注射,30 mg/次,每8 h注射1次,并联合振动排痰机对患者实施振动排痰。观察组在基础治疗上,给予盐酸氨溴索治疗,静脉注射,30 mg/次,每8 h注射1次,同时联合纤维支气管镜对患者实施排痰,并依据患者情况采用10~100 ml的生理盐水以不超13.3 kPa的负压进行灌洗治疗。比较2组患者治疗效果、发热消退时间、炎症消失时间、咳嗽消失时间、动脉血气指数及不良反应。结果观察组与对照组患者年龄、性别、病程、并发症等临床资料差异无统计学意义,具有可比性(P>0.05)。观察组患者总有效率高于对照组(P<0.05)。观察组患者发热消退时间、炎症消失时间和咳嗽消失时间均短于对照组(P<0.05)。治疗前,观察组与对照组患者的血气指标比较差异无统计学意义(P>0.05);治疗后,2组患者的动脉血氧分压、血氧饱和度和氧合指数均明显改善,并且观察组的动脉血氧分压、血氧饱和度、氧合指数、二氧化碳分压、pH、乳酸改善情况均优于对照组,差异有统计学意义(P<0.05)。对照组与观察组患者恶心、呕吐、皮疹、腹泻、瘙痒等不良反应总发生率比较,差异无统计学差异(P>0.05)。结论老年重症肺炎患者采用盐酸氨溴索联合纤维支气管镜吸痰治疗,能有效提高治疗效果,改善患者的血气指标,该治疗方式具有较好的临床应用价值。

Objective To investigate the clinical outcomes of ambroxol hydrochloride combined with sputum suction by fiberoptic bronchoscope in elderly patients with severe pneumonia and its effect on blood gas analysis indexes.Methods A total of 122 elderly patients with severe pneumonia admitted to Second Affiliated Hospital of Air Force Medical University from November 2017 to September 2022 were enrolled.They were divided into observation group and control group according to the different treatment methods.On the basis of basic treatment,the control group was treated with a vibration sputum extractor and intravenous injection of ambroxol hydrochloride(30 mg each time,q8h),and the observation group was treated with sputum suction by fiberoptic bronchoscope and intravenous injection of ambroxol hydrochloride(30 mg each time,q8h).Normal saline(10-100 ml)was used for irrigation treatment at a negative pressure≤13.3 kPa according to the patient's condition.The therapeutic effect,fever resolution time,inflammation resolution time,cough resolution time,arterial blood gas indexes,and adverse reactions of the 2 groups were analyzed.Results There was no significant difference in the age,sex,course of disease,or complications between the 2 groups(P>0.05).The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).The resolution time of fever,inflammation and cough in the observation group were significantly shorter than those in the control group(P<0.05).Before treatment,there was no significant difference in blood gas indexes between the 2 groups.After treatment,partial pressure of arterial oxygen,blood oxygen saturation,and oxygenation index were significantly improved in both groups.The improvement of partial pressure of arterial oxygen,blood oxygen saturation,oxygenation index,partial pressure of carbon dioxide,pH value,lactic acid in the observation group were significantly better than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions,such as nausea,vomiting,rash,diarrhea,or pruritus between the 2 groups(P>0.05).Conclusion Ambroxol hydrochloride and sputum suction through fiberoptic bronchoscope can effectively improve the treatment effect and blood gas indexes in elderly patients with severe pneumonia,and it has good clinical value.