俯卧位通气联合纤维支气管镜肺泡灌洗在重症肺炎合并急性呼吸衰竭治疗中的应用

Effectiveness of prone ventilation combined with fiberoptic bronchoscopy and alveolar lavage in treating severe pneumonia with acute respiratory failure

目的探讨俯卧位通气联合纤维支气管镜肺泡灌洗在重症肺炎合并急性呼吸衰竭治疗中的应用成效。方法将2022年1月至2023年7月就诊的200例重症肺炎合并急性呼吸衰竭随机分为3组,对照1组(67例)进行常规仰卧位通气,对照2组(66例)进行常规仰卧位通气,并予以纤维支气管镜肺泡灌洗,研究组(67例)进行俯卧位通气,并予以纤维支气管镜肺泡灌洗。观察各组治疗前后的简易肺部感染(clinical pulmonary infection score,CPIS)评分、动脉血气指标、血清炎症因子等变化,对比两组的治疗效果、ICU住院时间、总住院时间、28d死亡率等。结果3组治疗后的急性生理与慢性健康(APACHEⅡ)评分和CPIS评分均比入院时明显降低(P<0.05),并且研究组治疗后的APACHEⅡ评分、CPIS评分均低于对照1组和对照2组,对照2组的APACHEⅡ评分、CPIS评分明显低于对照1组(P<0.05)。3组治疗后的动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))、血氧饱和度(arterial oxygen saturation,SaO_(2))和氧合指数(PaO_(2)/FiO_(2))较入院时升高,动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO_(2))较入院时降低(P<0.05),组间对比显示,研究组治疗后的PaO_(2)、SaO_(2)和PaO_(2)/FiO_(2)水平比另外两组更高,PaCO_(2)水平比另外两组更低(P<0.05)。3组治疗后的血清C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、白细胞计数(white blood cell,WBC)及降钙素原(procalcitonin,PCT)水平较入院时明显降低,且组间比较显示研究组治疗后的各指标血清水平比另外两组更低(P<0.05)。研究组的治疗总有效率比另外两组更高,ICU住院时间、总住院时间比另外两组更短,28d死亡率比另外两组更低(P<0.05)。结论在重症肺炎合并急性呼吸衰竭的临床治疗中联用俯卧位通气和纤维支气管镜肺泡灌洗治疗有助于减轻机体炎症反应,改善血气指标,提高治疗效果,缩短患者的住院时间。

Objective To evaluate the efficacy of prone ventilation combined with fiberoptic bronchoscopy and alveolar lavage in the treatment of severe pneumonia with acute respiratory failure.Methods A total of 200 patients with severe pneumonia and acute respiratory failure from January 2022 to July 2023 were randomly assigned to three groups:control group 1(67 patients)received conventional supine ventilation;control group 2(66 patients)received supine ventilation with fiberoptic bronchoscopy and alveolar lavage;and the study group(67 patients)underwent prone ventilation combined with fiberoptic bronchoscopy and alveolar lavage.Changes in clinical pulmonary infection score(CPIS),arterial blood gas parameters,and serum inflammatory factors were observed.Treatment efficacy,ICU stay duration,total hospitalization time,and 28-day mortality were compared among the groups.Results Post-treatment APACHEⅡand CPIS scores significantly decreased in all groups compared to admission(P<0.05),with the study group showing lower scores than the other two groups.The APACHEⅡand CPIS scores in control group 2 were lower than those in control group 1(P<0.05).Post-treatment,partial pressure of oxygen in arterial blood(PaO_(2)),arterial oxygen saturation(SaO_(2)),and PaO_(2)/fraction of inspiration O_(2)(FiO_(2))levels increased while partial pressure of carbon dioxide in arterial blood(PaCO_(2))levels decreased compared to admission(P<0.05).The study group had higher PaO_(2),SaO_(2),and PaO_(2)/FiO_(2) levels,and lower PaCO_(2) levels than the other groups(P<0.05).Serum levels of C-reactive protein(CRP),interleukin-6(IL-6),white blood cell(WBC),and procalcitonin(PCT)decreased significantly in all groups,with the study group showing the lowest levels(P<0.05).The total effective treatment rate in the study group was higher,and both ICU stay and total hospitalization duration were shorter than in the other groups,with a lower 28-day mortality rate(P<0.05).Conclusion The combination of prone ventilation and fiberoptic bronchoscopy with alveolar lavage significantly alleviates the inflammatory response,improves blood gas parameters,enhances treatment efficacy,and reduces hospitalization time in patients with severe pneumonia and acute respiratory failure.