血必净联合纤维支气管镜吸痰灌洗治疗重症肺炎的疗效及对血清炎性因子水平的影响  

Xuebijing combined with sputum aspiration and bronchoalveolar lavage via fiberoptic bronchoscope in treatment of severe pneumonia and the effects on serum inflammatory cytokines level

作　　者：闫登峰[1] 朱春雨[1] 胡淼 YAN Dengfeng;ZHU Chunyu;HU Miao(Department of Respiratory Intensive Care Unit,Zhoukou Central Hospital,Zhoukou,Henan 466000,China)

机构地区：[1]周口市中心医院呼吸重症监护室,河南周口466000

出　　处：《安徽医药》2020年第4期759-762,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨血必净联合纤维支气管镜吸痰灌洗治疗重症肺炎病人的疗效及对血清炎性因子水平的影响。方法将周口市中心医院呼吸重症监护病房2018年3月至2019年2月收治的104例重症肺炎病人按随机数字表法分为对照组(n=50)和试验组(n=54),对照组应用纤维支气管镜吸痰灌洗,试验组给予血必净+纤维支气管镜吸痰灌洗治疗,比较两组治疗后疗效、机械通气时间、抗菌药物治疗使用时间、肺啰音消失时间、ICU住院时间,治疗前后氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SpO2)和血清肿瘤坏死因子 a(TNF α)、降钙素原(PCT)、C反应蛋白(CRP)水平等。结果治疗7 d后,试验组总体疗效优于对照组(P<0.05);治疗后,试验组机械通气时间(6.19±1.39)d、肺啰音消失时间(6.28±1.49)d、抗菌药物治疗使用时间(5.93±1.32)d和ICU住院时间(13.19±2.49)d显著短于对照组的(9.26±1.39)d、(10.24±2.20)d、(9.62±1.54)d、(17.84±3.24)d(P<0.05);治疗前两组PaCO2、PaO2、SpO2及血清TNF α、PCT、CRP水平组间比较均差异无统计学意义(P>0.05),治疗后试验组PaO2(83.24±6.50)mmHg、SpO2(93.16±7.29)%高于对照组的(73.53±5.76)mmHg、(84.62±6.82)%,PaCO2(43.07±3.61)mmHg和血清TNF α(51.29±6.68)ng/L、PCT(0.59±0.13)pg/L、CRP(23.66±3.06)mg/L水平低于对照组的(47.27±3.82)mmHg、(65.34±7.12)ng/L、(1.38±0.39)pg/L、(41.63±5.18)mg/L,差异有统计学意义(P<0.05)。结论血必净联合纤维支气管镜吸痰灌洗可降低重症肺炎机体炎症反应程度,改善血气分析指标,缩短ICU住院时间,提高临床疗效。Objective To explore the clinical efficacy of Xuebijing combined with sputum aspiration and bronchoalveolar lavage via fiberoptic bronchoscope in treatment of severe pneumonia and the effects on serum inflammatory cytokines level.Methods From March 2018 to February 2019,104 patients with severe pneumonia admitted to Respiratory Intensive Care Unit of Zhoukou Cen tral Hospital were assigned into control group(n=50)and experimental group(n=54)by numerical random table method.The control group received fiberoptic bronchoscopic sputum aspiration and bronchoalveolar lavage,while the experimental group re ceived Xuebijing combined with fiberopric bronchoscopy sputum aspiration and bronchoalveolar lavage.A comparison was made of the clinical efficacy,mechanical ventilation time,time of using antibacterial drug,time of disappearance of lung voice,stay in ICU,and the change in levels of partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),blood oxygen saturation(SpO2)and serum tumor necrosis factor α(TNF α),procalcitonin(PCT),C reactive protein(CRP)before and after treatment were compared between two groups.Results After 7d treatment,The clinical efficacy of the experimental group was better than that of the control group(P<0.05).After treatment,the mechanical ventilation time,time of disappearance of lung voice,time of us ing antibacterial drug,and stay in ICU in the experimental group were significantly shorter than those of the control group[(6.19±1.39)d vs.(9.26±1.39)d,(6.28±1.49)d vs.(10.24±2.20)d,(5.93±1.32)d vs.(9.62±1.54)d,(13.19±2.49)d vs.(17.84±3.24)d,re spectively;P<0.05].Before treatment,there were no significant differences in PaO2,PaCO2,SpO2 and serum TNF α,PCT,CRP lev els between two groups(P>0.05).After treatment,PaO2,SpO2of the experimental group were significantly higher than those in the control group[(83.24±6.50)mmHg vs.(73.53±5.76)mmHg,(93.16±7.29)%vs.(84.62±6.82)%,respectively;P<0.05],PaCO2 and serum TNF α,PCT,CRP levels of the experimental group were significant

关 键 词：肺炎 支气管肺泡灌洗 支气管镜检查 血必净 呼吸 人工 血气分析 肿瘤坏死因子α 降钙素基因相关肽 C反应蛋白质 

分 类 号：R563.1[医药卫生—呼吸系统]