纤维支气管镜肺泡灌洗对呼吸机相关性肺炎载脂蛋白E、降钙素原、NAMPT及呼吸力学指标、炎性相关因子的影响  

Effects of bronchoscopic alveolar lavage on apolipoprotein E,procalcitonin,NAMPT,respiratory mechanics indexes and inflammation-related factors of patients with ventilator-associated pneumonia

作　　者：李杨杨 李莉[1] 韩丽娜 LI Yangyang;LI Li;HAN Lina(Department of Respiratory Diseases,The First Hospital of Handan City,Hebei,Handan 056000,China)

机构地区：[1]河北省邯郸市第一医院呼吸一科,056000

出　　处：《河北医药》2021年第5期675-679,共5页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20171110)。

摘　　要：目的观察纤维支气管镜肺泡灌洗对呼吸机相关性肺炎(VAP)载脂蛋白E、降钙素原、烟酰胺磷酸核糖转移酶(NAMPT)及呼吸力学指标、炎性相关因子的影响。方法收治的117例VAP患者按照随机数字法分为2组,对照组49例行常规治疗,研究组68例加用纤维支气管镜肺泡灌洗治疗。治疗7 d后统计临床疗效,比较2组治疗前、治疗后简化CPIS评分,血清降钙素原、载脂蛋白E、NAMPT水平,PaO2、PaCO2、血氧饱和度,呼吸力学气道阻力、气道峰压、呼吸做功、动态顺应性变化。随访28 d内的临床结局,包括体温复常时间、肺部啰音消失时间、抗生素使用时间、咳嗽咳痰消失时间、机械通气时间及ICU住院时间。结果观察组总有效率为85.29%显著高于对照组的67.34%(P<0.05)。观察组体温复常时间、肺部啰音消失时间、抗生素使用时间、咳嗽咳痰消失时间、机械通气时间及ICU住院时间均少于对照组,脱机成功率高于对照组,差异均有统计学意义(P<0.05)。2组CPIS评分及血清CRP、IL-6、IL-8、TNF-α、降钙素原、载脂蛋白E、NAMPT水平均较治疗前下降(P<0.05),且治疗组低于对照组(P<0.05)。2组氧监测及呼吸动力学指标均较治疗前改善(P<0.05),且治疗组改善效果优于对照组(P<0.05)。结论纤维支气管镜肺泡灌洗治疗VAP能明显降低患者炎性相关因子水平,减轻患者肺部感染症状,促进呼吸功能恢复,改善患者预后,疗效确切。Objective To investigate the effects of bronchoscopic alveolar lavage on apolipoprotein E,procalcitonin,NAMPT,respiratory mechanics indexes and inflammation-related factors of patients with ventilator-associated pneumonia.Methods A total of 117 patients with VAP were divided into control group(n=49)and observation group(n=68)according to the random number method.The patients in control group were given routine treatment,however,the patients in observation group,on the basis of control group,were treated by fiberoptic bronchoalveolar lavage.After 7-day teatment,the clinical curative effects were observed.Moreover the CPIS scores before and after treatment,and the serum levels of procalcitonin,apolipoprotein E,NAMPT levels,PaO2,PaCO2,blood oxygen saturation,respiratory mechanics airway resistance,airway peak pressure,respiratory work,dynamic compliance changes as well as the clinical outcomes within 28 days of follow-up including the time of body temperature recovering to normal standard,extinction time of lung rales,antibiotics use duration,disappearing time of cough and sputum,mechanical ventilation time and the length to stay in ICU were observed and compared between the two groups.Results The total effective rate in observation group was 85.29%,which was significantly higher than that(67.34%)in control group(P<0.05).And the time of body temperature recovering to normal standard,extinction time of lung rales,antibiotics use duration,disappearing time of cough and sputum,mechanical ventilation time and the length to stay in ICU in observation group were significantly shorter than those in control group(P<0.05),moreover,the offline success rate in observation group was significantly higher than that in control group(P<0.05).After treatment the CPIS scores and serum levels of CRP,IL-6,IL-8,TNF-α,procalcitonin,apolipoprotein E,NAMPT in both groups were significantly decreased(P<0.05),moreover,which in observation group were significantly lower than those in control group(P<0.05).In addition the oxygen monitoring an

关 键 词：纤维支气管镜 肺泡灌洗技术 呼吸机相关性肺炎 载脂蛋白E 降钙素原 呼吸力学 

分 类 号：R563.1[医药卫生—呼吸系统]