经鼻高流量吸氧联合纤维支气管镜灌洗辅助治疗老年重症肺炎患者的临床效果

Clinical Effect of Nasal High-flow Oxygen Inhalation Combined with Fiberoptic Bronchoscopy Lavage in the Adjuvant Treatment of Elderly Patients with Severe Pneumonia

目的:探讨经鼻高流量吸氧联合纤维支气管镜灌洗辅助治疗老年重症肺炎患者的临床效果。方法:选择2021年9月-2023年9月于福建省老年医院呼吸与危重症学科住院的98例老年重症肺炎患者作为研究对象,按照随机数表法将患者分为对照组(n=49)和观察组(n=49)。两组均给予常规治疗+经鼻高流量吸氧干预,观察组联合纤维支气管镜灌洗辅助治疗。比较两组血气指标[二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、氧合指数(OI)],炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)]、肺功能[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)、最大呼气中期流量(MEF)]及死亡率。结果:观察组治疗后PaCO_(2)及IL-6、IL-8和TNF-α低于对照组,PaO_(2)、SaO_(2)、OI、FEV1、FVC、PEF、MEF高于对照组,差异有统计学意义(P<0.05);观察组治疗后3个月内死亡率低于对照组,差异有统计学意义(P<0.05)。结论:经鼻高流量吸氧联合纤维支气管镜灌洗辅助治疗老年重症肺炎患者能改善血气指标、肺功能及炎症因子水平,降低死亡率。

Objective:To evaluate the clinical effect of nasal high-flow oxygen inhalation combined with fiberoptic bronchoscopy lavage in the adjuvant treatment of elderly patients with severe pneumonia.Method:A total of 98 elderly patients with severe pneumonia who hospitalized in the Department of Respiratory and Critical Care Medicine of Fujian Provincial Geriatric Hospital from September 2021 to September 2023 were selected as the research objects,the patients were divided into the control group(n=49)and the observation group(n=49)according to the random number table method.Two groups were given routine treatment+nasal high-flow oxygen inhalation intervention,and the observation group was combined fiberoptic bronchoscopy lavage adjuvant treatment.The blood gas indexes[carbon dioxide partial pressure(PaCO_(2)),arterial oxygen partial pressure(PaO_(2)),blood oxygen saturation(SaO_(2)),oxygenation index(OI)],inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)],lung function[forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),peak expiratory flow(PEF),maximal mid-expiratory flow(MEF)]and mortality were compared between two groups.Result:The PaCO_(2),IL-6,IL-8 and TNF-αin the observation group after treatment,were lower than those in the control group,the PaO_(2),SaO_(2),OI,FEV1,FVC,PEF and MEF were higher than those in the control group,and the differences were statistically significant(P<0.05);the mortality rate of the observation group within 3 months of treatment was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:Nasal high-flow oxygen inhalation combined with fiberoptic bronchoscopy lavage in the adjuvant treatment of elderly patients with severe pneumonia can improve blood gas index,lung function and inflammatory factor levels,and reduce mortality.