吸入性乙酰半胱氨酸纤支镜肺泡灌洗方案联合头孢哌酮钠/舒巴坦钠治疗革兰阴性菌所致重症肺炎临床效果观察

Observation on the clinical effect of inhaled acetylcysteine fiberoptic bronchoalveolar lavage regimen combined with cefoperazone/sulbactam in the treatment of severe pneumonia caused by Gram-negative bacteria

目的探讨吸入性乙酰半胱氨酸(NAC)纤支镜肺泡灌洗方案联合头孢哌酮钠/舒巴坦钠治疗革兰氏阴性菌所致重症肺炎的效果及对血气指标、氧合指数及预后的影响。方法我院收治的160例革兰氏阴性菌所致重症肺炎患者,按照治疗方法不同分为对照组(常规对症治疗+头孢哌酮钠/舒巴坦钠治疗)和灌洗组(对照组治疗基础上+NAC纤支镜肺泡灌洗方案)各80例。比较两组治疗效果,对比治疗前后血气指标[动脉氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))和氧合指数(PaO_(2)/FiO_(2))]、血清炎症指标[单核细胞计数(MONO)、血清淀粉样蛋白A(SAA)和中性粒细胞计数(ANC)],记录重症加强监护时间、呼吸机使用时间、多器官衰竭率及死亡率等预后情况。结果灌洗组治疗有效率高于对照组(P<0.05);治疗1周后,两组血气指标中PaO_(2)、SaO_(2)和PaO_(2)/FiO_(2)水平均升高,PaCO_(2)水平降低,且灌洗组指标变化高于对照组(P<0.05);两组MONO、SAA和ANC水平均降低,且灌洗组低于对照组(P<0.05);灌洗组重症加强监护时间、呼吸机使用时间、多器官衰竭率低于对照组(P<0.05),两组不良事件发生率、28 d死亡率比较差异无统计学意义(P>0.05)。结论NAC纤支镜肺泡灌洗方案联合头孢哌酮钠/舒巴坦钠治疗革兰氏阴性菌所致重症肺炎疗效显著,可有效提高氧合水平,降低炎症反应,改善患者预后,值得推荐。

To explore the effect of fiberoptic bronchoscopic alveolar lavage regimen with inhaled N-acetylcysteine(NAC)combined with cefoperazone/sulbactam in the treatment of Gram-negative bacteria caused severe pneumonia and its influence on blood gas indicators,oxygenation index and prognosis.Methods One hundred and sixty patients with Gram-negative bacteria-caused severe pneumonia were selected.The patients were divided into a control group and a lavage group according to different treatment methods,80 in each group.The control group was treated with conventional symptomatic treatment+cefoperazone/sulbactam.The lavage group was treated with NAC fiberoptic bronchoscopic alveolar lavage regimen on the basis of the control group.The therapeutic effect was compared between the two groups.Blood gas indicators such as arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(SaO_(2))and oxygenation index(PaO_(2)/FiO_(2))and serum inflammatory markers such as monocyte count(MONO),serum amyloid A(SAA)and neutrophil count(ANC)before and after treatment were compared between the two groups.The prognosis status such as intensive care time,ventilator use time,multiple organ failure rate and mortality was recorded.Results The effective rate of treatment in the lavage group was significantly higher than that in the control group(P<0.05).After 1 week of treatment,the blood gas indicators of PaO_(2),SaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly increased(P<0.05)while the PaCO_(2)was significantly decreased(P<0.05),and the changes of the above indicators were significantly higher in the lavage group than those in the control group(P<0.05).The levels of MONO,SAA and ANC in the two groups were significantly reduced after 1 week of treatment(P<0.05),and the levels in the lavage group were significantly lower than those in the control group(P<0.05).The intensive care time,ventilator use time and multiple organ failure rate in the lavage group were significantly shorter or lower than those in the control group(P<0.05).There was no significant difference in the incidence rates of adverse events and in the 28d mortality between the two groups(P>0.05).Conclusions NAC fiberoptic bronchoscopic alveolar lavage regimen combined with cefoperazone/sulbactam have a significant efficacy in the treatment of Gram-negative bacteria caused severe pneumonia.It can effectively increase oxygenation level,reduce the inflammatory response,and improve the prognosis of the patients.It is worth recommending.