床旁纤维支气管镜灌洗对重症肺部感染患者血清细胞因子及临床效果的影响

Effect of Bronchoscopy Lavage on Serum Cytokines and Clinical Efficacy in Patients with Severe Pulmonary Infection

目的 探讨床旁纤维支气管镜灌洗对重症肺部感染患者血清细胞因子及临床效果的影响。方法 随机选择2021年5月—2023年6月贵州省习水县人民医院收治的80例危重症肺部感染者为研究对象。按照治疗方法的不同分为两组,各40例。对照组行常规治疗,观察组在对照组基础上使用床旁纤支镜灌洗治疗,比较两组患者治疗前、治疗后24 h及72 h的肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平,治疗前、后肺功能及动脉血氧分压变化及呼吸机治疗时间。结果 治疗后24 h及72 h,观察组TNF-α水平为(12.6±1.6)ng/L和(8.1±0.7)ng/L,均低于对照组的(27.4±4.3)ng/L和(15.1±2.1)ng/L,差异有统计学意义(t=20.402,20.000;P均<0.05)。治疗后,观察组第1秒用力呼气容积为(56.8±2.9)%,第1秒用力呼气容积与用力肺活量比值为(61.5±3.5)%,动脉血氧分压水平为(86.5±8.7)mmHg,均高于对照组的(46.5±2.1)%、(52.3±3.1)%、(71.1±4.2)mmHg,差异有统计学意义(t=18.194,12.445,10.082;P均<0.05)。观察组有创呼吸机治疗时间为(4.1±1.0)d,无创呼吸机治疗时间为(5.6±1.8)d,均短于对照组的(6.2±1.4)d、(8.9±2.7)d,差异有统计学意义(t=7.720,6.432;P均<0.05)。结论 危重症肺部感染患者采取纤维支气管镜肺泡灌洗治疗,可有效降低机体炎症因子,改善肺功能与机体氧合,缩短呼吸机治疗时间。

Objective To investigate the effects of bronchoscopy lavage on serum cytokines and clinical efficacy in patients with severe pulmonary infection.Methods 80 patients with critically ill pulmonary infection treated in Xishui County People's Hospital of Guizhou Province from May 2021 to June 2023 were randomly selected as the study objects.According to the different treatment methods were divided into two groups,40 cases each.The control group received conventional treatment,and the observation group,on the basis of the control group,used perfusion therapy with bedside bronchoscopy lavage.The levels of tumor necrosis factor-α(TNF-α) before treatment,24 h and 72 h after treatment,changes in lung function and arterial oxygen partial pressure before and after treatment,and the duration of ventilator therapy were compared between the two groups.Results At 24 h and 72 h after treatment,the TNF-α levels in the observation group were(12.6±1.6) ng/L and(8.1±0.7) ng/L,which were lower than those in the control group(27.4±4.3) ng/L and(15.1±2.1) ng/L,and the differences were statistically significant(t=20.402,20.000;both P<0.05).After treatment,the forced expiratory volume of the first second in the observation group was(56.8±2.9) %,the ratio of forced expiratory volume of the first second to forced vital capacity was(61.5±3.5) %,and the level of arterial blood oxygen partial pressure was(86.5±8.7) mmHg,which were higher than the control group(46.5±2.1) %,(52.3±3.1)%,(71.1±4.2) mmHg,the differences were statistically significant(t=18.194,12.445,10.082;all P<0.05).The treatment time of invasive ventilator in observation group was(4.1±1.0) d,and that of noninvasive ventilator was(5.6±1.8) d,which were shorter than those of control group(6.2±1.4) d and(8.9±2.7) d,the differences were statistically significant(t=7.720,6.432;both P<0.05).Conclusion Ronchoscopy lavage can effectively reduce inflammatory factors,improve lung function and oxygenation,and shorten the time of ventilator treatment in patients with severe pulmonary infection.