溶栓序贯抗凝治疗联合机械通气治疗腹腔感染合并急性肺栓塞肺损伤的疗效  

Efficacy of sequential thrombolytic therapy combined with mechanical ventilation in the treatment of lung injury due to abdominal infection combined with acute pulmonary embolism

作　　者：滕旭升 程江华[1] 章炳文 杨锡光[3] 华宏军[4] TENG Xu-sheng;CHENG Jiang-hua;ZHANG Bing-wen;YANG Xi-guang;HUA Hong-jun(Jinhua Central Hospital,Jinhua ,Zhejiang321000,China)

机构地区：[1]金华市中心医院急诊重症监护室,浙江金华321000 [2]金华市中心医院重症监护室,浙江金华321000 [3]金华市中心医院呼吸科,浙江金华321000 [4]金华市中心医院消化科,浙江金华321000

出　　处：《中华医院感染学杂志》2018年第23期3549-3552,3560,共5页Chinese Journal of Nosocomiology

基　　金：浙江省科学技术厅基金资助项目(2014C37024)

摘　　要：目的探讨溶栓序贯抗凝治疗联合机械通气治疗腹腔感染合并急性肺栓塞肺损伤的临床疗效。方法选取2015年6月-2017年8月医院收治的40例腹腔感染合并急性肺栓塞肺损伤患者作为研究对象,随机将40例患者分为试验组和对照组,每组20例。对照组患者使用常规溶栓联合抗菌药物治疗,试验组患者在常规抗菌治疗基础上使用溶栓序贯抗凝联合机械通气治疗,比较两组患者治疗情况。结果试验组患者总有效率为90.00%,高于对照组患者的60.00%(χ2=4.800,P=0.028);两组患者治疗后各项指标较治疗前均有所改善(P<0.05),试验组改善情况优于对照组(P<0.05);40例患者培养出44株病原菌,其中革兰阴性菌33株占75.00%、革兰阳性菌10株占22.73%、真菌1株占2.27%。结论使用溶栓序贯抗凝治疗联合机械通气治疗腹腔感染合并急性肺栓塞肺损伤效果较好,能快速缓解患者各项临床症状,治疗安全性高。OBJECTIVE To investigate the clinical efficacy of sequential anticoagulant thrombolysis combined with mechanical ventilation in the treatment of acute lung injury associated with abdominal infection and acute pulmonary embolism.METHODS Forty patients with acute lung injury due to abdominal infection and acute pulmonary embolism admitted in our hospital from Jun.2015 to Aug.2017 were selected and randomly divided into two groups:experimental group(20 cases)and control group(20 cases).Patients in the control group were treated with conventional thrombolysis combined with antimicrobial drugs.The experimental group was treated with thrombolytic and sequential anticoagulation combined with mechanical ventilation on the basis of conventional antimicrobial therapy.The treatment of the two groups was compared.RESULTS The clinical efficacy of the experimental group(90.00%)was significantly better than that of the control group(70.00%)(χ2= 4.800,P< 0.05).After treatment,the blood gas indexes in both groups were improved as compared to that before treatment,and the improvement of the experimental group was significantly better than that of the control group(P< 0.05).A total of 44 strains of pathogens were isolated from the 40 cases of patients,among which there were 33 strains of gram-negative bacteria accounting for 75.00%,10 strains of gram-positive bacteria accounting for 22.73%,and 1 strain of fungus accounting for 2.27%.CONCLUSIONSequential anticoagulant therapy with thrombolytic therapy combined with mechanical ventilation is effective in treating acute lung injury due to abdominal infection complicated with acute pulmonary embolism.It can quickly relieve various clinical symptoms of patients with high safety and has promotion value.

关 键 词：溶栓序贯抗凝 机械通气 腹腔感染 急性肺栓塞 肺损伤 

分 类 号：R563.5[医药卫生—呼吸系统]