经纤维支气管镜阿米卡星肺泡灌洗治疗对ICU重症肺炎患者的影响研究  

Effect of Alveolar Lavage with Amikacin via Bronchofibroscope on Patients with Severe Pneumonia in ICU

作　　者：陈静[1] 龚宗炼[2] Chen Jing;Gong Zonglian(Department of Intensive Medicine,Affiliated Hospital of Northern Sichuan Medical College,Nanchong 637000,China;Department of Respiratory Medicine,Affiliated Hospital of Northern Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院重症医学科,南充637000 [2]川北医学院附属医院呼吸内科,南充637000

出　　处：《成都医学院学报》2018年第6期690-694,699,共6页Journal of Chengdu Medical College

基　　金：四川省科技厅科技支撑计划项目(No:2014SZ03689)

摘　　要：目的探讨经纤维支气管镜阿米卡星肺泡灌洗治疗对重症监护室(ICU)重症肺炎患者的临床效果。方法回顾性分析124例ICU重症肺炎患者临床资料,所有患者均接受常规治疗,其中经纤维支气管镜阿米卡星肺泡灌洗治疗者纳入试验组(n=67),采用相同方式生理盐水灌洗治疗者纳入对照1组(n=35),未应用灌洗治疗者纳入对照2组(n=22)。比较治疗前及治疗1周后3组患者呼吸力学指标[气道阻力(Raw)、气道峰压(PIP)、呼吸末正压(PEEP)、气道平台压(Pplat)、肺静态顺应性(Cst)]、白细胞计数(WBC)、血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)]、气道炎症因子[白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、白三烯B4(LTB4)]、血清生化指标[C反应蛋白(CRP)、降钙素原(PCT)、基质金属蛋白酶抑制剂-1(TIMP-1)]变化,分析治疗1周后3组患者治疗效果差异。结果治疗后1周,3组Raw、PIP、PEEP、Pplat、WBC、PaCO2、IL-4、IL-6、LTB4、CRP、PCT、TIMP-1水平均较治疗前下降,组间比较试验组<对照1组<对照2组,差异均有统计学意义(P<0.05);3组Cst、PaO2、OI水平均较治疗前提升,组间比较试验组>对照1组>对照2组,差异均有统计学意义(P<0.05);治疗总有效率比较试验组>对照1组>对照2组,组间比较均有统计学意义(P<0.05)。结论经纤维支气管镜阿米卡星肺泡灌洗治疗可改善ICU重症肺炎患者肺顺应性、氧合功能及气道炎症因子水平,有利于预后疾病转归。Objective To investigate the clinical effect of alveolar lavage with amikacin via bronchofibroscope on patients with severe pneumonia in intensive care unit(ICU).Methods The clinical data of124patients with severe pneumonia in ICU were analyzed retrospectively.All those patients were given the conventional treatment.The patients treated with amikacin alveolar lavage by bronchofibroscope were included in the experiment group(n=67),those treated with saline lavage in the same way were included in the1st control group(n=35),and those treated without any lavage therapy were included in the2nd control group(n=22).The respiratory mechanics indexes including air way resistance(Raw),peak inspiratory pressure(PIP),positive end-expiratory pressure(PEEP),airway platform pressure(Pplat)and static lung compliance(Cst),white blood count(WBC),blood gas indexes including arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2)and oxygenation index(OI),airway inflammation factors including interleukin-4(IL-4),interleukin-6(IL-6)and leukotriene B4(LTB4),serum biochemical indicators including C-reactive protein(CRP),procalcitonin(PCT)and tissue inhibitor of metalloproteinase-1(TIMP-1)before and1week after treatment were compared between the three groups to analyze the differences of the clinical effect after1week of treatment.Results The levels of Raw,PIP,PEEP,Pplat,WBC,PaCO2,IL-4,IL-6,LTB4,CRP,PCT and TIMP-1after1week of treatment were significantly lower than those before treatment in the three groups and they were the lowest in the experiment group and the highest in the2nd control group according to the Results of the comparisons between groups,and all the differences statistically significant(P<0.05).The levels of Cst,PaO2and OI were all significantly higher than those before treatment in the three groups and they were the highest in the experiment group and the lowest in the2nd control group,and all the differences statistically significant(P<0.05).The total effective rate of treatment was

关 键 词：纤维支气管镜 阿米卡星 肺泡灌洗 重症肺炎 

分 类 号：R459.7[医药卫生—急诊医学]