支气管肺泡灌洗治疗重型颅脑损伤后肺部感染的效果观察  

Observation of Effect of Bronchoalveolar Lavage in Patients with Pulmonary Infection after Severe Traumatic Brain Injury

作　　者：李建[1] 宋婷婷[1] 马龙[1] 钟华[1] 于湘友[1] 

机构地区：[1]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054

出　　处：《临床误诊误治》2015年第1期94-98,共5页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金资助项目(81160232)

摘　　要：目的观察支气管肺泡灌洗(bronchoalveolar lavage,BAL)治疗重型颅脑损伤合并肺部感染的效果及安全性。方法选择我院收治的重型颅脑损伤合并肺部感染患者78例,采用随机数字表法分为观察组和对照组各39例。两组均给予常规治疗,观察组于确诊肺部感染后首日即予BAL治疗。观察两组治疗前及治疗后1、3、5日血气分析指标[血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、氧合指数(Pa O2/Fi O2)],炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及预后指标[机械通气天数、重症监护病房(ICU)住院天数、抗生素使用天数、肺部感染持续时间及28 d病死率]的变化,并记录并发症发生情况。结果两组治疗后Pa O2、Pa CO2、Pa O2/Fi O2、IL-6、TNF-α均较治疗前改善,且治疗后各时间点上述指标均优于对照组,差异均有统计学意义(P<0.05)。观察组机械通气天数、ICU住院天数、抗生素使用天数、肺部感染持续时间均显著短于对照组(P<0.05),两组28 d病死率比较差异无统计学意义(P>0.05)。观察组无严重BAL相关并发症发生。结论 BAL治疗可显著改善重型颅脑损伤合并肺部感染患者氧合功能,控制肺部炎症。Objective To observe the effects and safety of bronchoalveolar lavage（BAL） in patients with pulmonary infection after severe traumatic brain injury. Methods Patients were randomly divided into the treatment group and the control group（n = 39,each） using random digit table. All the patients were treated with conventional therapy,and the treatment group was treated with BAL besides conventional therapy. Results The results of blood gas analysis showed that the levels of PaO2 and Pa O2/ Fi O2 in the treatment group were significantly higher than that of the control group（P〈0.05）,while the level of PaO2 was significantly lower than that of the control group（P〈0.05）. Compared with the control group at the same time,the plasma IL-6 and TNF-α levels were obviously lower than those before treatment,and the levels were decreased more significantly in the treatment group than that in the control group. Duration of ICU stay,days of antibiotic use,and days of mechanical ventilation were significantly fewer in the treatment group than that in the control group. There was no significant difference in mortality rate between the two groups（P〉0. 05）. There was no serious BAL related complications in the treatment group. Conclusion The BAL can significantly increase the oxygenation,control the pulmonary infection.

关 键 词：支气管镜 支气管肺泡灌洗 颅脑损伤 并发症 呼吸道感染 

分 类 号：R651.15[医药卫生—外科学]