纤维支气管镜灌洗术治疗支气管扩张合并肺部感染的疗效评价

Effect of fiberoptic bronchoscopy with bronchoalveolar lavage in the treatment of bronchiectasis complicated with pulmonary infection

目的评价经纤维支气管镜肺泡灌洗治疗支气管扩张合并肺部感染的疗效,旨在为临床治疗支气管扩张合并肺部感染提供临床依据。方法将2015年10月—2016年10月期间皖北煤电集团总医院收治的40例支气管扩张合并肺部感染患者采用随机数字表法随机分为2组,对照组给予常规内科治疗,如吸氧、平喘、祛痰、抗感染等;观察组在常规治疗的基础上采用经纤维支气管镜肺泡灌洗治疗。对比2组的临床疗效、并发症、脉血气分析指标、呼吸频率变化情况以及临床症状与体征改善情况。结果观察组中治疗无效5例,临床治疗总有效率为75.0%,对照组中治疗无效9例,临床治疗总有效率为55.0%,差异无统计学意义(χ~2=1.777,P=0.320);经系统治疗后,观察组患者的PaO_2、PaO_2/FiO_2等指标与治疗前比较均有明显改善(P<0.05);对照组的PaO_2水平与治疗前比较均有明显改善(P<0.05);观察组患者的PaO_2、PaO_2/FiO_2等指标均优于对照组(P<0.05);观察组的咳嗽咳痰消失时间、住院时间均低于对照组,差异有统计学意义(均P<0.05);观察组中出现窦性心动过速1例,心率高至100~150次/min,术后恢复正常;血氧饱和度下降3例,术后快速恢复90%以上,并发症发生率为20.0%。对照组出现呛咳3例,经吸氧机对症治疗后咳嗽、咳痰症状消失,并发症发生率为15.0%。2组的并发症发生率比较差异不具有统计学意义(~χ2=0.032,P=0.859)。结论经纤维支气管镜支气管肺泡灌洗治疗支气管扩张合并肺部感染的疗效可靠,可明显改善患者的炎症反应,促进心肺功能恢复。

Objective To evaluate the efficacy of fiberoptic bronchoscopy with bronchoalveolar lavage in the treatment of bronchiectasis complicated with pulmonary infection,so as to provide a clinical basis for the treatment of bronchiectasis with pulmonary infection. Methods Total 40 cases of bronchiectasis with pulmonary infection were randomly divided into 2 groups,the control group received routine medical treatment,such as oxygen,asthma,expectorant and anti-infection; the observation group received bronchoalveolar lavage based on routine treatment. The clinical efficacy,complications,pulse blood gas analysis index,respiratory rate changes and the improvement of clinical symptoms and signs were compared between the two groups. Results In the observation group,5 cases were invalid,the total efficiency of clinical treatment was75%; 9 cases were ineffective in the control group,the clinical total effective rate was 55%,the difference was statistically significant( P < 0. 05). After the treatment,PaO_2,PaO_2/FiO_2 and respiratory rate in the two groups were no statistical significance( P > 0. 05). The cough disappeared time and hospitalization time in the observation group were lower than those in the control group,the difference was statistically significant( P < 0. 05). In the observation group,there was 1 case of sinus tachycardia,the heart rate was up to 100-150 times/min,and recovered after the operation; there were 3 cases of decreased oxygen saturation,and 90% of them recovered rapidly after the operation with a complication incidence of 20%.In the control group there were 3 cases of cough,and the symptoms of cough and expectoration disappeared after symptomatic treatment by oxygen inhalation machine. The incidence of complication was 15%. The difference in the incidence of complication between the two groups was not statistically significant( t = 6. 955,P < 0. 05). Conclusion Bronchoalveolar lavage is effective in the treatment of bronchiectasis complicated with pulmonary infection. It can obviously improve the inflammatory reaction and promote the recovery of heart and lung function.