经纤维支气管镜肺泡灌洗术联合亚胺培南西司他丁钠治疗重症肺炎的疗效观察  

Effect of bronchofiberoscope alveolar lavage combined with imipenem and cilastatin sodium for injection in the treatment of severe pneumonia

作　　者：巫兴阳 杨呈浩[2] 黄小勇[1] WU Xing-yang;YANG Cheng-hao;HUANG Xiao-yong(Department of Critical Care Medicine;Department of Neurosurgery,the Fourth People s Hospital of Zigong Zigong,643000,Sichuan,China)

机构地区：[1]自贡市第四人民医院重症医学科,四川自贡643000 [2]自贡市第四人民医院神经外科,四川自贡643000

出　　处：《川北医学院学报》2021年第7期898-901,共4页Journal of North Sichuan Medical College

基　　金：2019年四川省医学(青年创新)科研课题(S19070)。

摘　　要：目的:探讨经纤维支气管镜肺泡灌洗术(BAL)与注射用亚胺培南西司他丁钠联合治疗重症肺炎的临床效果。方法:选取104例重症肺炎患者为研究对象,按照治疗方式不同分为观察组和对照组,每组各52例。对照组采用亚胺培南西司他丁钠治疗;观察组在对照组基础上联合BAL治疗,疗程7 d;比较两组患者临床疗效、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SpO_(2))、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)、白介素8(IL-8)、白介素6(IL-6))、肺部感染量表(CPIS)评分、Murray肺损伤量表(MLIS)评分、急性生理学及慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分及随访1年因重症肺炎再入院率。结果:观察组临床治疗总有效率高于对照组(P<0.05)。治疗后,两组患者PaCO_(2)、TNF-α、PCT、IL-8及IL-6水平和CPIS、MLIS及APACHE-Ⅱ评分均降低(P<0.05),且观察组低于对照组(P<0.05);PaO_(2)及SpO_(2)升高(P<0.05),且观察组高于对照组(P<0.05)。观察组患者随访1年因重症肺炎再住院率低于对照组(P<0.05)。结论:BAL与亚胺培南西司他丁钠联合可增强治疗重症肺炎的疗效,改善血气及血清炎性因子水平,且有利于患者预后,值得推广使用。Objective:To analyze the efficacy of bronchoalveolar lavage(BAL)combined with injection of imipenem and cilastatin in the treatment of severe pneumonia.Methods:104 patients with severe pneumonia were selected as the research objects.According to different treatment plans,they were divided into observation group and control group,52 cases in each group.The control group received conventional treatment+imipenem and cilastatin sodium injection,and the observation group received BAL treatment on the basis of the control group.The course of treatment for both groups was 7 days.The clinical efficacy and adverse reactions of the two groups were observed,and the blood gas indexes(PaO_(2),PaCO_(2),SpO_(2))and serum inflammatory factors(TNF-α,PCT,IL-8,IL-6)levels before and after treatment were analyzed.The CPIS,MLIS,and APACHE-Ⅱscores before and after treatment were compared between the two groups,and the rates of rehospitalization due to severe pneumonia were recorded in the two groups after 1 year of follow-up.Results:The total effective rate of clinical treatment in the observation group was significantly higher than that in the control group(P<0.05).After treatment,PaCO_(2),TNF-α,PCT,IL-8 and IL-6 levels and CPIS,MLIS and Apache-Ⅱscores in the two groups were significantly decreased(P<0.05),and the observation group was lower than the control group(P<0.05).PaO_(2) and SpO_(2) were increased(P<0.05),and the observation group was higher than the control group(P<0.05).The rehospitalization rate of the observation group was lower than that of the control group during the 1-year follow-up(P﹤0.05).Conclusion:BAL combined with imipenem and cilastatin sodium for injection can effectively treat severe pneumonia,improve blood gas indicators and serum inflammatory factor levels,and benefit the prognosis of patients,which is worthy of promotion.

关 键 词：重症肺炎 纤维支气管镜 肺泡灌洗 血气分析 炎性因子 肺部感染评分量表 Murray肺损伤评分量表 APACHE-Ⅱ评分 

分 类 号：R563.1[医药卫生—呼吸系统]