探讨多重耐药菌重症肺炎经纤支镜支气管肺泡灌洗临床效果  

Analysis of Clinical Effect of Bronchoalveolar Lavage in Severe Pneumonia with Multi-drug Resistant Bacteria

作　　者：刘仁杰 常双喜[1] 王锦涛[1] 刘雅莉 LIU Ren-jie;CHANG Shuang-xi;WANG Jin-tao(Department of Respiratory and Critical Care Medicine,Zhengzhou First People’s Hospital,Zhengzhou,Henan,450004,China)

机构地区：[1]郑州市第一人民医院呼吸与危重症医学科,河南郑州450004

出　　处：《黑龙江医学》2022年第14期1713-1717,共5页Heilongjiang Medical Journal

摘　　要：目的:探讨多重耐药菌重症肺炎经纤支镜支气管肺泡灌洗的临床疗效和安全性。方法:选取郑州市第一人民医院2016年4月—2020年1月收治的67例多重耐药菌重症肺炎患者。随机分为两组,对照组(A组)33例,采用抗感染、祛痰、翻身、振动排痰、吸痰、体位引流、吸氧及机械通气等常规治疗方法。治疗组(B组)34例,在常规治疗方法基础上给予经纤支镜支气管肺泡灌洗治疗,治疗5 d后比较两组患者临床治疗效果。结果:治疗组与对照组比较血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))、相对危险度(RR)、心率(HR),治疗组比对照组心肺功能改善更明显,差异无统计学意义(t=2.756、0.507、0.507、3.254、3.047,P>0.05)。治疗组与对照组比较体温(T)、白细胞(WBC)、中性粒细胞(N)、C反应蛋白(CRP)、降钙素原(PCT)、肺部感染评分(CPIS)、急性生理与慢性健康评分(APACHEII),治疗组比对照组肺部炎症病变控制效果更好,差异无统计学意义(F=1.138、0.011、0.146、0.125、0.018、0.436、0.896,P>0.05)。治疗组与对照组比较显效率、总有效率,治疗组显效率、总有效率比对照组高,临床治疗效果显著。结论:多重耐药菌重症肺炎经纤支镜支气管肺泡灌治疗临床效果确切,操作简便安全,值得在临床上推广应用。Objective:To explore the clinical efficacy and safety of bronchoalveolar lavage with multi-drug resistant bacteria in severe pneumonia by fiberbronchoscope.Methods:A total of 67 patients with severe pneumonia caused by multidrug-resistant bac⁃teria admitted to the hospital from April 2016 to January 2020 were selected and randomly divided into two groups.The control group(group A)of 33 people received conventional treatment methods such as anti-infection,expectorant,turning over,vibration expectoration,sputum suction,postural drainage,oxygen inhalation and mechanical ventilation.34 patients in the treatment group(group B)were given bronchoalveolar lavage via fiberoptic bronchoscopy on the basis of conventional treatment.After 5 d of treat⁃ment,the clinical therapeutic effects of the two groups were compared.Results:Compared with the control group,the treatment group showed more significant improvement in blood oxygen saturation(SpO_(2)),arterial partial pressure of oxygen(PaO_(2)),oxygenation index(PaO_(2)/FiO_(2)),relative risk(RR),and heart rate(HR),the difference was totstatistically significant(t=2.756,0.507,0.507,3.254,3.047,P>0.05).The body temperature(T),white blood cells(WBC),neutrophils(N),C-reactive protein(CRP),procalcito⁃nin(PCT),pulmonary infection score(CPIS),and acute physiology and chronic health scores in treatment group(APACHEII)were better than those in the control group,the difference was notstatistically significant(F=1.138,0.011,0.146,0.125,0.018,0.436,0.896,P>0.05).The markedly effective rate and the total effective rate of the treatment group were higher than those of the con⁃trol group,and the clinical treatment effect was remarkable.Conclusion:Bronchial alveolar lavage with multi-drug resistant bacte⁃ria for severe pneumonia by fibrobronchoscopy has definite clinical effect,simple and safe operation,and is worthy of clinical application。

关 键 词：多重耐药菌 重症肺炎 支气管肺泡灌洗 

分 类 号：R653.1[医药卫生—外科学]