矽肺病患者肺部局部感染后抗感染与支气管灌洗治疗对肺通气功能及疗效的分析  

Clinical effect of anti-infection therapy combined with bronchial lavage on treatment of silicosis patients complicated with pulmonary infections on pulmonary ventilation function

作　　者：陈伟文[1] 郭伟峰[2] 徐萌[2] 沈冰寒[2] 李翠梅[2] 王志刚 

机构地区：[1]福建医科大学附属泉州第一医院重症医学科,福建泉州362000 [2]福建医科大学附属泉州第一医院呼吸内科,福建泉州362000 [3]泉州市医学专科高等学校附属人民医院呼吸内科,福建泉州362000

出　　处：《中华医院感染学杂志》2018年第1期32-36,共5页Chinese Journal of Nosocomiology

基　　金：福建医科大学非直属附属医院科研发展专项基金资助项目(FZS13028Y)

摘　　要：目的探讨抗感染联合支气管灌洗在治疗伴有肺部局部感染矽肺病患者的临床疗效及对其肺通气功能的影响。方法选取医院2015年8月-2017年1月收治的105例矽肺合并肺部局部感染患者纳入本研究,按入院先后将上述患者分为试验组57例和对照组48例;对照组患者给予持续低流量吸氧、平喘止咳、化痰等常规治疗,并根据其痰液培养结果及药敏结果合理选用抗菌药物进行抗感染治疗,试验组患者则在上述基础上采用纤维支气管镜进行肺泡灌洗治疗;比较两组患者的临床疗效及肺通气功能。结果试验组患者的总有效率为91.23%,高于对照组的77.08%(P<0.05);治疗前,两组患者的常规肺功能水平和脉冲振荡肺功能状况比较差异无统计学意义,治疗后,试验组的X5水平高于对照组,而R5、R20及Fres水平则低于对照组(P<0.05);治疗前,两组患者的血气分析结果及6min步行试验结果比较差异无统计学意义;治疗后,试验组患者的SaO2、PaO2水平和PaCO2水平分别为(93.57±8.03)%、(86.59±7.12)mmHg、(48.86±4.04)mmHg,同时其6min步行试验结果为(338.59±21.09)m,与对照组结果[(86.28±8.46)%、(81.85±6.57)mmHg、(53.53±4.28)mmHg、(316.78±20.32)m]比较,差异有统计学意义(P<0.05);试验组患者的胸闷、胸痛,咳痰,咳嗽喘息,肺啰音以及紫绀等各临床症状消失均早于对照组(P<0.05);试验组患者的感染控制时间、白细胞恢复正常时间、中性粒细胞恢复正常时间以及肺部阴影消失时间均短于对照组(P<0.05)。结论在治疗矽肺并发肺部局部感染上,抗感染联合支气管灌洗治疗效果明显,能够有效改善患者的肺部通气功能及其动脉血气状况,临床症状快速改善,使其临床疗效得到进一步提高。OBJECTIVE To explore the clinical effect of anti-infection therapy combined with bronchial lavage on treatment of silicosis patients complicated with pulmonary infections on pulmonary ventilation function.METHODS A total of 105 silicosis patients complicated with pulmonary infections who were treated in hospitals from Aug 2015 to Jan 2017 were enrolled in the study and divided into the experimental group with 57 cases and the control group with 48 cases according to the order of admission. The control group was given the conventional therapies such as continuous low flow oxygen inhalation, asthma and cough relieving, and phlegm reducing, and the pa- tients were treated with antibiotics based on the results of sputum culture and drug susceptibility testing; the ex- perimental group was given additional bronchial lavage by using fiberoptic bronchoscopy on basis of the treatmentof the control group. The clinical curative effect and pulmonary ventilation function were observed and compared between the two groups of patients. RESULTS The total effective rate of the experimental group was 91.23%, higher than 77.08% of the control group （P〈0.05）.There was no significant difference in the conventional pulmo- nary function level or impulse oscillation pulmonary function between the two groups of patients before the treat- ment ; the X5 level of the experimental group was significantly higher than that of the control group after the treat- ment, however, the levels of RS, R20 and Fres of the experimental group were significantly lower than thost of the control group （P 〈0.05）.There was no significant difference in the result of blood gas analysis or 6-minute walking test between the two groups of patients before the treatment; the levels of SaO2 , PaO2 and PaCOz were respectively （93.57±8.03） %, （86.59± 7.12） mmHg and （48.86 ± 4.04） mmHg in the experimental group and were respectively （86.28±8.46）%, （81.85±6.57）mmHg and （53.53±4.28）mmHg in the control group; the re- sult of 6-minut

关 键 词：抗感染治疗 支气管灌洗 矽肺病 肺部局部感染 肺通气功能 

分 类 号：R563.1[医药卫生—呼吸系统]