纤维支气管镜联合抗生素灌洗治疗ICU机械通气合并肺部感染的临床转归分析  

Analysis on the clinical outcome of fiberoptic bronchoscopy combined with antibiotic lavage in treating mechanical ventilation with pulmonary infection in ICU

作　　者：李绚梅 邓爱兵 兰伟途 徐锋 LI Xuan-mei;DENG Ai-bing;LAN Wei-tu(Department of Pulmonary and Critical Care Medicine,Cangzhou People's Hospital,Cangzhou 061000,China;不详)

机构地区：[1]沧州市人民医院呼吸与危重症医学科,河北沧州061000 [2]沧州市人民医院神经外科,河北沧州061000

出　　处：《中国医学装备》2020年第5期139-143,共5页China Medical Equipment

基　　金：河北省重点研发项目(18277781D)“全身用药联合局部微创介入技术治疗肺癌的临床研究”;沧州市科技支撑计划(162302100)“气管镜技术在重症肺部感染性疾病中的应用研究”。

摘　　要：目的:研究纤维支气管镜联合抗生素灌洗治疗重症监护室(ICU)机械通气合并肺部感染的临床转归。方法:选取医院收治的90例ICU机械通气合并肺部感染患者,按照随机数表法将其分为观察组和对照组,每组45例,对照组采用常规抗生素治疗;观察组在对照组治疗方法的基础上采用纤维支气管镜联合抗生素灌洗治疗。比较两组临床疗效,分析两组治疗前后动脉血氧饱和度(SpO2)、血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、白细胞计数(WBC)、中性粒细胞百分比、血清C反应蛋白(CRP)和降钙素原(PCT)水平,对比两组治疗前后呼吸功能(WOB)及动态肺顺应性(DLC),并观察两组不良反应发生情况。结果:观察组治疗总有效率为93.33%,对照组为73.33%,差异有统计学意义(x2=6.480,P<0.05);两组治疗后SpO2和PaO2均高于治疗前,PaCO2均低于治疗前,差异有统计学意义(t观察组=6.113,t=15.312,t=9.472;t对照组=3.670,t=12.089,t=5.971;P<0.05);治疗后观察组SpO2、PaO2和PaCO2水平与对照组比较,差异有统计学意义(t=2.033,t=2.777,t=4.217;P<0.05);治疗后两组CRP、WBC及PCT均低于治疗前,中性粒细胞高于治疗前(t=15.824,t=14.571,t=8.099,t=3.073,t=14.497,t=9.202,t=7.215,t=2.294;P<0.05),观察组治疗后CRP、WBC及PCT均低于对照组,中性粒细胞高于对照组(t=34.616,t=6.318,t=7.736,t=4.117;P<0.05);两组治疗后DLC高于治疗前(t=8.105,t=7.234;P<0.05),WOB低于治疗前(t=28.314,t=8.372;P<0.05);观察组治疗后WOB低于对照组(t=22.754,P<0.05),DLC与对照组比较差异无统计学意义。两组不良反应总发生率差异无统计学意义。结论:纤维支气管镜联合抗生素灌洗治疗ICU机械通气合并肺部感染效果好,安全性高,具有一定临床应用价值。Objective:To study the clinical outcome that fiberoptic bronchoscopy combined with antibiotic lavage to treat mechanical ventilation with pulmonary infection in intensive care unit(ICU).Methods:90 patients with mechanical ventilation combined with pulmonary infection in ICU admitted to hospital were randomly divided into observation groups(45 cases)and control group(45 cases)by random number table method.The patients of control group were treated by routine antibiotics,while those of observation group were treated by fiberoptic bronchoscopy combined with antibiotic lavage on the basis of control group.The clinical effects of the two groups were compared.The arterial oxygen saturation(SpO2),partial pressure of blood oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),white blood cell count(WBC).percentage of neutrophils,serum C-reactive protein(CRP).procalcitonin(PCT)levels of two groups between pre and post treatment were analyzed.The work of breathing(WOB)and dynamic lung compliance(DLC)of two groups between pre and post treatment were compared,and the incidence of adverse reactions of two groups were observed.Results:The total effective rate was 93.33%in observation group and that was 73.33%in control group(x2=6.480,P<0.05).And the levels of SpO2 and PaO2 in both two groups post treatment were significantly higher than those pretreatment(t=6.113,t=3.670,t=15.312,t=12.089,P<0.05).and the level of PaCO2 post treatment was significantly lower than that pretreatment(t=9.472,t=5.971,P<0.05),respectively.After treatment,the levels of SpO2 and PaO2 of observation group were significantly higher than those of control group(t=2.033,t=2.117,P<0.05),and the level of PaCO2 of observation group was significantly lower than that of control group(t=4.217,P<0.05),respectively.And the levels of CRP,WBC and PCT of two groups post treatment were significantly lower than those pretreatment,while the level of neutrophils post treatment was significantly higher than that pretreatment(t=15.824,t=14.571,t=8.099,t=3.073,t=14.497,t=9

关 键 词：纤维支气管镜 抗生素灌洗 重症监护室 机械通气 肺部感染 

分 类 号：R445.1[医药卫生—影像医学与核医学]