纤维支气管镜对严重呼吸机相关性肺炎患者呼吸力学参数的影响  

Influence of fiberoptic bronchoscopy on respiratory mechanical parameters of patients with severe ventilator-associated pneumonia

作　　者：杨勋[1] 陈贝贝[1] 张明华[1] 赵苏[1] 莫冰泉 

机构地区：[1]武汉市中心医院呼吸内科,湖北武汉430014 [2]东莞市塘厦医院中医科,广东东莞523710

出　　处：《中华医院感染学杂志》2015年第8期1781-1783,共3页Chinese Journal of Nosocomiology

基　　金：广东省卫生厅基金资助项目(A20026725)

摘　　要：目的探讨纤维支气管镜对严重呼吸机相关性肺炎患者临床症状及呼吸力学参数的影响,为临床制定干预措施提供依据。方法选取医院2011年6月-2014年10月收治的80例严重呼吸机相关性肺炎患者作为研究对象,随机分为观察组和对照组,每组各40例,两组患者确诊后均给予常规抗菌药物治疗,对照组在此基础上给予常规灌洗吸痰,观察组则给予纤维支气管镜肺泡灌洗吸痰治疗,对治疗过程中两组患者的呼吸力学参数、肺部感染情况及临床疗效进行比较分析。结果观察组在治疗1h和4h后气道峰压(PIP)、动态顺应性(Cdyn)、气道阻力(Raw)及呼吸功(WOB)参数均明显优于对照组;治疗后两组患者CPIS评分相比治疗前均有不同程度改善,观察组治疗3、5、7d的评分相比对照组明显降低;治疗后观察组痊愈29例占72.5%,显效9例占22.5%,对照组痊愈16例占40.0%,显效18例占45.0%,差异有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗吸痰治疗严重呼吸机相关性肺炎可有效改善患者的临床感染症状和呼吸功能,具有显著的临床疗效。OBJECTIVE To study the influence of fiberoptic bronchoscopy on the clinical symptoms and respiratory mechanical parameters of the patients with severe ventilator-associated pneumonia so as to put forward clinical interventions.METHODS A total of 80 patients with severe ventilator-associated pneumonia who were treated in the hospital from Jun 2011 to Oct 2014 were recruited as the study objects and randomly divided into the observation group and the control group,with 40 cases in each.Both groups were treated with conventional antibiotics after the diagnosis,the control group was given the additional conventional antibiotics,while the observation group was treated with bronchotracho alveolar larvage and suctioning under fiberoptic bronchoscopy.The respiratory mechanical parameters,prevalence of pulmonary infections,and clinical efficacy were observed and compared between the two groups during the treatment process.RESULTS After the treatment for 1or 4hours,the parameters such as the peak airway pressure,dynamic compliance,airway resistance,and work of breathing of the observation group were significantly better than those of the control group.The CPIS scores of both groups were improved to some extent after the treatment,and the CPIS scores on day 3,5,and 7of the observation group were significantly less than those of the control group.After the treatment,29（72.5%）cases were cured in the observation group,16（40.0%）cases in the control group;9（22.5%）cases were effective in the observation group,18（45.0%）cases in the control group,and there was statistically significant（P〈0.05）.CONCLUSION As for the treatment of the patients with severe ventilator-associated pneumonia,the bronchotracho alveolar larvage and suctioning under fiberoptic bronchoscopy can achieve remarkable clinical effect on improving the clinical symptoms of infections and respiratory function.

关 键 词：呼吸机相关性肺炎 纤维支气管镜 呼吸力学 

分 类 号：R563.1[医药卫生—呼吸系统]