纤维支气管镜支气管肺泡灌洗对高位脊髓损伤患者坠积性肺炎的疗效分析  

Effective analysis of fiberoptic bronchoscopy combined with bronchoalveolar lavage in patients of high level spinal cord injury with hypostatic pneumonia

作　　者：田洪成[1] 金永成[2] 

机构地区：[1]中国康复研究中心危重症医学科,北京100068 [2]航天中心医院神经外科

出　　处：《中国现代医药杂志》2014年第9期6-8,共3页Modern Medicine Journal of China

摘　　要：目的探讨纤维支气管镜检查和支气管肺泡灌洗对高位脊髓损伤患者呼吸机相关性肺炎的疗效。方法随机选取本院高位脊髓损伤患者需要机械通气已行气管切开确诊为呼吸机相关性肺炎患者(60例)作为研究对象,随机分为给予纤维支气管镜吸痰、支气管肺泡灌洗处理的治疗组(30例)和常规治疗的对照组(30例)。两组患者均采用抗生素、化痰、排痰药物、无菌吸痰管吸痰、机械排痰、体位引流等常规治疗措施。对患者治疗后不同时间的临床肺部感染评分(CPIS)、抗生素应用时间、住ICU时间、10天脱机成功率及2月死亡率等进行分析。结果治疗组治疗后CPIS评分较对照组明显下降,其抗生素应用时间缩短、住ICU时间缩短、呼吸机辅助通气时间缩短,较对照组有显著的统计学意义。结论对于高位脊髓损伤合并呼吸机相关性肺炎患者采取经纤维支气管镜吸痰结合支气管肺泡灌洗能明显提高疗效,值得临床推广应用。Objective To explore the curative effect of fiberoptic bronchoscopy combined with bronchoalveolar lavage in patients of high level spinal cord injury with ventilator-associated pneumonia. Methods Sixty patients of high-level spinal cord injury with mechanical ventilation through tracheotomy and acquired ventilator-associated pneumonia were randomly divid- ed into control group （n=30） and treatment group （n=30）. The treatment group were treated with bronchoalveolar larvage fluid （BAL）. The control group accepted routine treatment. All patients accepted anti-infection ,nutritional support, dissipate phlegm, aspiration of sputum with germ free sputum tube, mechanical assistance for expulsion of phlegm, postural drainage treatments etc. The therapeutic effects in the two groups were evaluated and compared from clinical pulmonary infection score （CPISs）, an- tibiotic application time, hospitalization days in ICU, 10 days offline success rate, 2 months mortality. Results CPISs, antibiotic application time, hospitalization days in ICU, time of mechanical ventilation of treatment group were shorter than those in control group （P〈0.05）. Conclusion Fiberoptic bronchoscopy combined with bronchoalveolar lavage is a safe and effective method to treat the patients with high level spinal cord injury combined with hypostatic pneumonia. It is worth application in clinic.

关 键 词：高位脊髓损伤 坠积性肺炎 纤维支气管镜 支气管肺泡灌洗术 

分 类 号：R651.2[医药卫生—外科学] R563.1[医药卫生—临床医学]