支气管肺泡灌洗联合机械通气对脑外伤并肺部感染患者的应用  

Use of bronchoalveolar lavage and assisted ventilation in pulmonary closure complicated with infection due to brain injury

作　　者：樊天明[1] 

机构地区：[1]中南大学湘雅二医院外科,湖南长沙410011

出　　处：《中国内镜杂志》2009年第12期1264-1266,1270,共4页China Journal of Endoscopy

摘　　要：目的评价对脑外伤并肺部感染患者联合应用支气管肺泡灌洗与机械通气治疗的效果。方法将该院78例脑外伤并肺部感染患者随机分为A、B两组,每组39例,A组接受常规治疗(包括抗生素、化痰、湿化气管、拍背促进排痰、营养及支持治疗)及联合应用支气管肺泡灌洗(BAL)与呼吸机辅助通气治疗,B组仅行常规治疗,比较两组患者的治疗效果。结果A组患者治愈24例,显效9例,好转4例,无效2例,有效率为95.1%;B组治愈15例,显效8例,好转5例,无效11例,有效率为72.3%.两组比较差异有显著性(P<0.01)。A组患者抗感染时间为(8.7±0.3)d,B组为(11.9±0.5)d,两组比较差异有显著性(P<0.01)。A组发生窒息和呼吸衰竭各1例(发生率为5.1%),B组分别为2例和4例(发生率为15.3%),两组发生率比较差异有显著性(P<0.01)。B组1例因呼吸循环衰竭死亡。A组患者在BAL治疗过程中,4例血氧饱和度降至70%以下,经暂停操作、呼吸机辅助呼吸后恢复并完成治疗;5例发生心动过速,3例发生心动过缓,无心跳骤停发生。结论对脑外伤并肺部感染患者联合应用支气管肺泡灌洗与机械通气治疗可提高有效率,缩短治疗时间,减少窒息和呼吸衰竭的发生,改善预后。[ Objective ] To investigate the chnical outcome of bronchoalveolar lavage （BAL） and mechanical ventilation for the treatment of pulmonary closure complicated with infection due to brain injury. [Methods] Totally 78 patients with pulmonary infection after tracheotomy due to brain injury were included in this study. All patients were randomized into 2 groups with each group of 39. Routine management （including antibiotics, eliminating sputum, humidificating airway, clapping back to facilitate excluding sputum, nutritional and supportive treatment） and BAL with assisted ventilation were administered in group A. Patients in group B underwent routine management alone. The clinic outcomes of 2 groups were compared. [ Results ] In group A, 24 patients were completely cured, 9 patients were gready improved, 4 patients were improved, and 2 patients had poor outcome with the total improving rate of 95.1%. While in group B, 15 patients were completely cured, 8 patients markedly improved, 5 patients were improved, and 11 patients had poor outcome with the improving rate of 72.3%, the difference was significant between both groups （P〈0.01）. The infection duration of group A was （8.7±0.3） days, and group B was （11.9±0.5） days with significant difference （P 〈0.01）. In group A, 1 case was complicated with respiratory failure and 1 case with asphyxia （the incidence was 5.1%）, while in group B, the occurrence of respiratory failure and asphyxia was 2 and 4 cases （the incidence was 15.3%） respectively, the difference was significant （P〈0.01）, 1 patient in group B died of respiratory and circulatory failure. During the procedure of BAL in group A, the saturation of blood oxygen decreased to no more than 70% in 4 patients, who recovered eventually by suspending the operation and assisted ventilation, 5 patients had tachycardia, 3 patients had bradycardia, while no cardiac arrest was noted. [ Conclusion ] Use of BLA and assisted ventilation is effective to deal with pulmonary closure compli

关 键 词：脑外伤 肺部感染 机械通气 支气管肺泡灌洗 

分 类 号：R651.15[医药卫生—外科学]