乙酰半胱氨酸溶液局部注入联合支气管肺泡灌洗治疗卒中相关性肺炎的临床研究

Clinical Study of Acetylcysteine Solution Local Injection Combined with Bronchoalveolar Lavage in the Treatment of Stroke Associated Pneumonia

目的:探讨乙酰半胱氨酸溶液局部注入联合支气管肺泡灌洗治疗卒中相关性肺炎(SAP)的临床效果。方法:选择阳江市第三人民医院内一科2021年7月—2023年4月收治的SAP患者100例,采用随机数字表法分为观察组与对照组,各50例。对照组予抗感染、经纤维支气管镜吸痰和肺泡灌洗治疗,观察组在对照组基础上联合乙酰半胱氨酸溶液局部注入治疗。比较两组临床疗效、治疗前后血清炎症因子水平与呼吸功能,观察两组治疗过程中发生的不良反应和并发症。结果:观察组治疗总有效率(96.00%)高于对照组(78.00%),差异有统计学意义(P<0.05)。两组治疗前C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平比较,差异均无统计学意义(P>0.05);治疗后两组血清炎症因子水平均有所下降,观察组CRP、PCT、TNF-α水平均低于对照组(P<0.05)。两组治疗前氧合指数(OI)、气道阻力(Raw)、动脉血二氧化碳分压(PaCO_(2))比较,差异均无统计学意义(P>0.05);治疗后两组OI均高于治疗前,Raw、PaCO_(2)均低于治疗前,观察组OI高于对照组,Raw、PaCO_(2)均低于对照组(P<0.05)。两组均未发生治疗相关不良反应和并发症。结论:乙酰半胱氨酸溶液局部注入联合支气管肺泡灌洗治疗SAP效果显著,能够有效下调患者血清炎症因子水平,改善呼吸功能,安全性高。

Objective:To investigate the clinical effect of Acetylcysteine Solution local injection combined with bronchoalveolar lavage in the treatment of stroke associated pneumonia(SAP).Method:A total of 100 SAP patients admitted to the Third People's Hospital of Yangjiang City from July 2021 to April 2023 were selected and divided into observation group and control group according to random number table method,with 50 cases in each group.The control group was treated with anti-infection,sputum suctioning via flexible bronchoscope and bronchoalveolar lavage,and the observation group was treated with Acetylcysteine Solution local injection on the basis of control group.The clinical efficacy,before and after treatment of serum inflammatory factors levels and respiratory function were compared between the two groups,and the adverse reactions and complications occurred in the course of treatment between the two groups were observed.Result:The total effective rate of the observation group(96.00%)was higher than that of the control group(78.00%),the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in the levels of C reactive protein(CRP),procalcitonin(PCT)and tumor necrosis factor-α(TNF-α)between the two groups before treatment(P>0.05).After treatment,the levels of serum inflammatory factors were decreased in both groups,and the levels of CRP,PCT and TNF-αin observation group were lower than those in control group(P<0.05).Before treatment,there were no significant differences in oxygenation index(OI),airway resistance(Raw)and arterial partial pressure of carbon dioxide(PaCO_(2))between the two groups before treatment(P>0.05).After treatment,OI in both groups were higher than those before treatment,Raw and PaCO_(2) were lower than those before treatment,OI in observation group was higher than that in control group,Raw and PaCO_(2) in observation group were lower than those control group(P<0.05).There were no treatmentrelated adverse reactions and complications in the two groups.Conclusion:Acetylcysteine Solution local injection combined with bronchoalveolar lavage in the treatment of SAP is effective,can effectively reduce the level of serum inflammatory factors,improve respiratory function,and high safety.