纤维支气管镜吸痰联合肺泡灌洗对肺癌术后合并肺部感染患者呼吸功能和血清IL-6、TNF-α和hs-CRP水平的影响

Effects of fiberoptic bronchoscopy sputum aspiration combined with alveolar lavage on respiratory function and levels of serum IL⁃6,TNF⁃αand hs⁃CRP in lung cancer patients with postoperative pulmonary infection

目的探讨纤维支气管镜(FOB)吸痰联合肺泡灌洗对肺癌术后合并肺部感染患者呼吸功能和血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hs-CRP)水平的影响。方法选取2018年9月至2021年9月自贡市第一人民医院接受治疗的肺癌术后合并肺部感染患者96例,以随机数字表法分为两组,每组48例。对照组接受机械通气联合吸痰管吸痰治疗,实验组在对照组基础上予以FOB吸痰联合肺泡灌洗治疗。比较两组治疗1周后总有效率;对比两组治疗前、治疗1周后血气指标[二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、血氧饱和度(SpO_(2)%)、酸碱度(pH值)]、呼吸功能指标[呼吸做功(WOB)、气道阻力(RAW)、动态顺应性(Cdyn)、气道峰压(PIP)]、临床肺部感染评分(CPIS)、炎性因子IL-6、TNF-α、hs-CRP水平;对比两组治疗过程中不良反应发生情况。结果治疗后,实验组的总有效率高于对照组,差异有统计学意义(χ^(2)=5.031,P<0.05);实验组血气指标、临床肺部感染CPIS评分、呼吸功能指标结果较对照组更优,差异有统计学意义(t=3.032,5.530,2.008,5.136,9.344,8.549,3.681,3.557,7.778,P<0.05);实验组治疗后的血清炎性因子IL-6、TNF-α、hs-CRP水平低于对照组,差异有统计学意义(t=21.327,17.291,16.748,P<0.05)。治疗期间两组不良反应发生率比较无统计学意义(χ^(2)=0.274,P>0.05)。结论FOB吸痰联合肺泡灌洗用于肺癌术后肺部感染患者能够显著提高治疗效果,促进患者呼吸功能恢复,有效抑制炎症,具有较高的安全性。

Objective To explore the effects of fiberoptic bronchoscopy(FOB)sputum aspira⁃tion combined with alveolar lavage on respiratory function and levels of serum interleukin⁃6(IL⁃6),tumor ne⁃crosis factor⁃α(TNF⁃α)and hypersensitive C⁃reactive protein(hs⁃CRP)in lung cancer patients with postoper⁃ative pulmonary infection.Methods A total of 96 patients with lung infections after lung cancer surgery at Zigong First People's Hospital were enrolled between September 2018 and September 2021.Using the random number table method,they were divided into a control group(mechanical ventilation combined with a sputum aspiration tube)and an experimental group(FOB sputum aspiration combined with alveolar lavage on the ba⁃sis of the control group),with 48 cases in each group.The total response rate after a week of treatment,par⁃tial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),oxygen saturation(SpO_(2)%),potential of hydrogen(pH)before and after a week of treatment,work of breathing(WOB),air way resistance(RAW),dynamic compliance(Cdyn),peak airway pressure(PIP),clinical pulmonary infection score(CPIS),levels of inflammatory factors(IL⁃6,TNF⁃α,hs⁃CRP),and the occurrence of adverse reactions dur⁃ing treatment were compared between the two groups.Results After treatment,the total response rate of the experimental group was higher than that of the control group(χ^(2)=5.031,P<0.05).After treatment,blood gas indexes,respiratory function indexes,and CPIS in the experimental group were better than those in the control group(t=3.032,5.530,2.008,5.136,9.344,8.549,3.681,3.557,7.778,P<0.05).Furthermore,after treat⁃ment,the levels of serum IL⁃6,TNF⁃αand hs⁃CRP in the experimental group were lower than those in the control group(t=21.327,17.291,16.748,P<0.05).There was no significant difference in the incidence of ad⁃verse reactions between the two groups during treatment(χ^(2)=0.274,P>0.05).Conclusion FOB with sputum aspiration and alveolar lavage can greatly enhance treatment outcomes,facilitate respiratory function re overy,and effectively suppress inflammation in patients with lung infections following lung cancer surgery,all while maintaining a high level of safety.