支气管肺泡灌洗并局部灌注抗菌药物在难治性肺部感染患者中的应用分析

Application of bronchoalveolar lavage and localized infusion of antibiotics in patients with refractory pulmonary infection

目的本研究旨在评估支气管肺泡灌洗并局部灌注抗菌药物治疗难治性肺部感染患者的疗效及病原菌分布情况。方法本研究为随机对照试验。选取2020年6月至2023年6月在西安市胸科医院接受治疗的难治性肺部感染患者100例,按照随机数字表法分为对照组(50例)与观察组(50例)。对照组男21例,女29例,年龄(58.23±2.33)岁,体重指数(22.13±2.12)kg/m^(2),接受常规治疗,连续治疗9 d。观察组男24例,女26例,年龄(60.12±3.05)岁,体重指数(21.53±2.31)kg/m^(2),在常规治疗基础上接受支气管肺泡灌洗并局部注射抗菌药物治疗,1次/3 d,连续治疗3次。统计并比较两组患者血清指标、痰培养病原菌清除情况及耐药性。采用χ^(2)检验、t检验进行统计分析。结果治疗9 d后,两组患者血清总氧化态(TOS)、C反应蛋白(CRP)、腺苷脱氨酶(ADA)、氧化应激指数(OSI)、肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、降钙素原(PCT)、肾素(R)、血管紧张素Ⅱ(AngⅡ)均较治疗前下降,总抗氧化态(TAS)均较治疗前上升(均P<0.05);观察组患者血清TOS、CRP、TAS、ADA、OSI、TNF-α、IL-8、PCT、R、AngⅡ分别为(13.65±1.39)μmol/L、(13.02±1.89)mg/L、(3.01±1.01)μmol/L、(42.36±3.85)U/L、(5.54±1.06)U/L、(14.65±2.56)ng/L、(99.67±13.54)ng/L、(16.27±4.66)ng/L、(1.23±0.45)ng/L、(23.14±6.43)ng/L,对照组上述指标分别为(15.54±2.68)μmol/L、(25.38±2.14)mg/L、(2.25±0.97)μmol/L、(50.28±4.11)U/L、(7.25±1.02)U/L、(26.57±5.12)ng/L、(148.39±21.28)ng/L、(22.57±4.53)ng/L、(1.98±0.65)ng/L、(36.86±8.11)ng/L,差异均有统计学意义(t=4.427、30.611、3.838、9.944、8.220、14.724、13.659、6.855、6.708、9.374,均P<0.05)。观察组治疗有效率高于对照组[92.00%(46/50)比76.00%(38/50)],差异有统计学意义(χ^(2)=4.762,P=0.029)。治疗前,对照组患者痰培养共检出病原菌55株,其中革兰阴性菌31株(56.36%)、革兰阳性菌24株(43.64%);观察组患者痰培养共检出病原菌53株,其中革兰阴性菌34株(64.15%)、革兰阳性菌19株(35.85%)。治疗9 d后痰培养结果显示,观察组的病原菌清除率高于对照组[76.00%(38/50)比54.00%(27/50)],差异有统计学意义(χ^(2)=5.319,P=0.021)。结论支气管肺泡灌洗并局部灌注抗菌药物治疗可以显著改善难治性肺部感染患者的生化指标水平,提高病原菌清除率,改善患者预后,为重症肺部感染患者提供了一种新的治疗选择。

Objective To evaluate the effect of bronchoalveolar lavage and localized infusion of antibiotics on refractory pulmonary infection and its impact on distribution of pathogenic bacteria.Methods This study was a randomized controlled trial.A total of 100 patients with refractory pulmonary infection treated in Xi'an Chest Hospital from June 2020 to June 2023 were selected and were divided into a control group(50 cases)and an observation group(50 cases)according to the random number table method.In the control group,there were 21 males and 29 females,aged(58.23±2.33)years,with a body mass index of(22.13±2.12)kg/m^(2),who received conventional treatment,and the efficacy was evaluated after 9 days of continuous treatment.In the observation group,there were 24 males and 26 females,aged(60.12±3.05)years,with a body mass index of(21.53±2.31)kg/m^(2),who received bronchoalveolar lavage and localized injection of antibiotics on the basis of conventional treatment,once every 3 days,and the efficacy were evaluated after 3 consecutive treatments.The serum indicators,clearance of pathogenic bacteria in sputum culture,and drug resistance of the two groups were compared.χ^(2) test and t test were used.Results After 9 days of treatment,serum levels of total oxidation state(TOS),C-reactive protein(CRP),adenosine deaminase(ADA),oxidative stress index(OSI),tumor necrosis factorα(TNF-α),interleukin-8(IL-8),procalcitonin(PCT),renin(R),and angiotensinⅡ(AngⅡ)in both groups were decreased compared with those before treatment,and the levels of total antioxidant state(TAS)were increased compared with those before treatment(all P<0.05);serum levels of TOS,CRP,ADA,OSI,TNF-α,IL-8,PCT,R,and AngⅡin the observation group were(13.65±1.39)μmol/L,(13.02±1.89)mg/L,(42.36±3.85)U/L,(5.54±1.06)U/L,(14.65±2.56)ng/L,(99.67±13.54)ng/L,(16.27±4.66)ng/L,(1.23±0.45)ng/L,and(23.14±6.43)ng/L,which were lower than those in the control group[(15.54±2.68)μmol/L,(25.38±2.14)mg/L,(50.28±4.11)U/L,(7.25±1.02)U/L,(26.57±5.12)ng/L,(148.39±21.28)ng/L,(22.57±4.53)ng/L,(1.98±0.65)ng/L,and(36.86±8.11)ng/L],and the TAS level was higher than that in the control group[(3.01±1.01)μmol/L vs.(2.25±0.97)μmol/L],with statistically significant differences(all P<0.05).The total effective rate of the observation group was higher than that of the control group[92.00%(46/50)vs.76.00%(38/50)],with a statistically significant difference(χ^(2)=4.762,P=0.029).Before treatment,55 strains of pathogenic bacteria were detected in the sputum culture of the control group,including 31 strains of gram-negative bacteria(56.36%)and 24 strains of gram-positive bacteria(43.64%);53 strains of pathogenic bacteria were detected in the sputum culture of the observation group,including 34 strains of gram-negative bacteria(64.15%)and 19 strains of gram-positive bacteria(35.85%).Sputum culture after 9 days of treatment showed that the clearance rate of pathogenic bacteria in the observation group was higher than that in the control group[76.00%(38/50)vs.54.00%(27/50)],with a statistically significant difference(χ^(2)=5.319,P=0.021).Conclusions Bronchoalveolar lavage and localized infusion of antibiotics can significantly improve the biochemical indexes in patients with refractory pulmonary infection,increase the clearance rate of pathogenic bacteria,and improve the patients'prognosis.This provides a new treatment option for patients with severe lung infection.