纤维支气管镜在不间断机械通气重症肺炎诊治中的应用  

Application of fiberoptic bronchoscope in the diagnosis and treatment of continuous mechanical ventilation patients with severe pneumonia

作　　者：陈亮[1] 朱蓉[1] 洪永青[1] 孟自力[1] 

机构地区：[1]南京医科大学附属淮安第一医院呼吸科,江苏淮安223300

出　　处：《临床肺科杂志》2017年第4期662-666,共5页Journal of Clinical Pulmonary Medicine

基　　金：基金项目:江苏省卫生计生委2015年度面上科研(NoH201554)

摘　　要：目的研究不间断机械通气纤维支气管镜防污染毛刷(PSB)获取下呼吸道标本在重症肺炎患者病原学诊断中的价值和应用纤维支气管镜吸痰及支气管肺泡灌洗(BAL)治疗的安全性及疗效。方法选取120例重症肺炎合并有创机械通气患者,将其分为治疗组和对照组,各60例。两组均接受机械通气,对照组使用无菌吸痰管吸取下呼吸道分泌物,治疗组接受PSB获取患者下呼吸道标本并行支气管镜吸痰及BAL治疗。结果治疗组气管镜PSB采样较对照组病原体培养阳性率高(P<0.05);和对照组相比,治疗组经气管镜吸痰及BAL治疗后氧分压和氧合指数明显增高,C反应蛋白(CRP)明显下降,总有效率和痰菌转阴率明显增高(P<0.05);治疗组机械通气时间及住院时间较对照组明显缩短(P<0.05)。结论对于重症肺炎患者,不间断机械通气下、气管镜PSB比无菌吸痰管采样更易能获得准确的病原体,气管镜吸痰及BAL治疗重症肺炎疗效确切,术中危险性小,值得推广。Objective To explore the etiological diagnosis value of fiberoptic bronchoscope preventive speci- mens brush （PSB） to acquire lower respiratory tract specimens and security and efficacy of bronchoscopy suction and bronchoalveolar lavage （BAL） treatment in continuous mechanical ventilation of patients with severe pneumonia. Methods 120 cases of severe pneumonia with invasive mechanical ventilation were selected and randomly divided into the treatment group and the control group. The two groups were treated with mechanical ventilation, the treatment group （ n = 60） received PSB to collect lower respiratory tract specimens for pathogenic bacteria isolation and bron- choscopic sputum aspiration and BAL treatment, and the control group （n = 60） was given sterile suction tube to draw the lower respiratory tract secretions. Results The pathogen culture positive rate of sputum in the treatment group was significantly higher than in the control group （ P 〈 0. 05 ）. The PaO2 and oxygenation index in the treatment group increased and CRP also decreased more obviously after bronchoscopie aspiration and BAL treatment than in the control group （P 〈 0. 05）. The total effective rate and sputum negative conversion rate in the treatment group were significantly higher than in the control group （ P 〈 0. 05 ）. The time of mechanical ventilation and the duration of hos- pital stay in the treatment group were shorter than in the control group （ P 〈 0. 05 ）. Conclusion PSB is more easily to acquire accurate pathogen in continuous mechanical ventilation patients with severe pneumonia. The bronehoscope aspiration and BAL treatment is effective and safe, which is worthy of promotion in patients with severe pneumonia with continuous mechanical ventilation.

关 键 词：机械通气 纤维支气管镜 肺部感染 防污染毛刷 

分 类 号：R563.1[医药卫生—呼吸系统]