纤维支气管镜灌洗联合大剂量盐酸氨溴索对老年重症肺炎患者炎性因子的影响

Effect of fiberoptic bronchoscopic lavage combined with high-dose ambroxol hydrochloride on inflammatory factors in elderly patients with severe pneumonia

目的探讨纤维支气管镜灌洗联合大剂量盐酸氨溴索对老年重症肺炎患者炎性因子的影响。方法108例老年重症肺炎患者作为研究对象,以随机数字表法分为A组和B组,各54例。两组均进行常规治疗,A组给予常规剂量盐酸氨溴索治疗,B组给予纤维支气管镜灌洗联合大剂量盐酸氨溴索治疗。比较两组临床疗效,治疗前后的血气分析指标[动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))及氧合指数(PaO_(2)/FiO_(2))]水平、炎性因子[C反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)、中性粒细胞比例(NEUT%)]水平及急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)评分,呼吸机带机时间。结果B组和A组治疗14 d后的总有效率分别为96.30%、79.63%,与A组比较,B组较高(P<0.05)。两组治疗14 d后的SaO_(2)、PaO_(2)及PaO_(2)/FiO_(2)水平均比治疗前高,且B组PaO_(2)/FiO_(2)(314.53±33.58)mm Hg(1 mm Hg=0.133 kPa)高于A组的(267.48±31.71)mm Hg(P<0.05)。两组治疗14 d后的血清CRP、WBC、PCT、NEUT%水平均比治疗前低,且B组CRP(14.76±2.42)mg/L、WBC(6.75±1.02)×109/L、PCT(0.13±0.04)ng/L、NEUT%(49.45±3.36)%均低于A组的(18.65±3.34)mg/L、(10.32±1.21)×109/L、(0.41±0.11)ng/L、(56.25±4.37)%(P<0.05)。两组治疗14 d后的APACHEⅡ评分均比治疗前低,且B组APACHEⅡ评分(10.43±1.01)分低于A组的(15.75±3.76)分(P<0.05);B组呼吸机带机时间(6.54±0.76)d短于A组的(12.65±0.32)d(P<0.05)。结论纤维支气管镜灌洗联合大剂量盐酸氨溴索可控制老年重症肺炎病情发展,缩短患者呼吸机带机时间,改善患者血气指标,并减轻机体炎症反应,进而提高临床疗效。

Objective To explore the effect of fiberoptic bronchoscopic lavage combined with high-dose ambroxol hydrochloride on inflammatory factors in elderly patients with severe pneumonia.Methods 108 elderly patients with severe pneumonia were divided into group A and group B by random number table method,each with 54 cases.Both groups received conventional treatment.Group A received conventional dose of ambroxol hydrochloride treatment,and group B received fiberoptic bronchoscopic lavage combined with high-dose ambroxol hydrochloride treatment.Comparison was made on clinical efficacy,blood gas analysis indicators[arterial oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PaO_(2)),and oxygenation index(PaO_(2)/FiO_(2))],inflammatory factors[C-reactive protein(CRP),white blood cell count(WBC),procalcitonin(PCT),neutrophil percentage(NEUT%)],Acute Physiology and chronic Healthy EvaluationⅡ(APACHEⅡ)score,ventilator supporting time between the two groups.Results The total effective rates of group B and group A after 14 d of treatment were 96.30%and 79.63%,respectively.Compared with group A,group B had a higher total effective rate(P<0.05).After 14 d of treatment,SaO_(2),PaO_(2) and PaO_(2)/FiO_(2) levels in both groups were higher than those before treatment;and PaO_(2)/FiO_(2) of(314.53±33.58)mm Hg(1 mm Hg=0.133 kPa)in group B was higher than(267.48±31.71)mm Hg in group A(P<0.05).After 14 d of treatment,the levels of serum CRP,WBC,PCT and NEUT%were all lower than those before treatment;group B had CRP of(14.76±2.42)mg/L,WBC of(6.75±1.02)×109/L,PCT of(0.13±0.04)ng/L and NEUT%of(49.45±3.36)%,which were lower than(18.65±3.34)mg/L,(10.32±1.21)×109/L,(0.41±0.11)ng/L and(56.25±4.37)%in group A(P<0.05).After 14 d of treatment,the APACHEⅡscore in both groups was lower than that before treatment,and the APACHEⅡscore of(10.43±1.01)points in group B was lower than(15.75±3.76)points in group A(P<0.05).The ventilator supporting time of(6.54±0.76)d in group B was shorter than(12.65±0.32)d in group A(P<0.05).Conclusion Fiberoptic bronchoscopic lavage combined with high-dose ambroxol hydrochloride can control the development of severe pneumonia in elderly patients,shorten the ventilator supporting time,improve the blood gas indicators of patients,and reduce the inflammatory response,so as to improve the clinical efficacy.