纤维支气管镜局部灌洗对吸入性损伤后血清炎症因子及肺功能影响的临床观察  

Clinical observation of effect of local lavage on serum inflammatory factors and pulmonary function in patients with inhalation injury

作　　者：王锦涛[1] 李晓亮[1] 禹彩霞[1] WANG Jintao;LI Xiaoliang;YU Caixia(Department of Respiratory 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内科,河南郑州450004

出　　处：《中国医学工程》2023年第2期68-72,共5页China Medical Engineering

基　　金：河南省医学科技攻关项目(LHGJ20200700)。

摘　　要：目的 探讨纤维支气管镜局部灌洗治疗烧伤并吸入性损伤患者血清炎症因子、肺功能及预后情况的临床分析。方法 回顾性分析郑州市第一人民医院烧伤科重症监护病房2018年1月至2021年12月收治的符合入选标准的362例烧伤并发吸入性损伤患者的病历资料。根据不同治疗方法将患者分为纤维支气管镜局部灌洗组(治疗组) 152例和常规气道灌洗组(对照组) 210例。比较两组的呼吸机机械通气时间、住ICU时间、各项血清炎症因子水平、肺功能指标水平、动脉血气指标水平,并比较两组的休克期补液量和治疗前后的各项生命体征、不良反应及伤后28 d死亡情况。结果 治疗组呼吸机机械通气时间、ICU住院时间短于对照组(P<0.05);治疗组血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)和白介素-6(IL-6)水平低于对照组(P<0.05);治疗组第一秒最大呼气容积(FEV_(1))、用力肺活量比值(FEV_(1)/FVC)、最大呼气流量(PEF)均高于对照组(P<0.05);治疗后治疗组动脉氧分压(PaO_(2))、血氧饱和度(SpO_(2))高于对照组(P<0.05),治疗组动脉二氧化碳分压(PaCO_(2))低于对照组(P<0.05),治疗组休克期血浆、乳酸钠林格氏液、5%葡萄糖注射液总输入量均低于对照组(P<0.05);治疗后两组患者心率、体温及平均动脉压均下降,治疗组低于对照组(P<0.05),两组患者低氧血症、呼吸性酸中毒、呼吸性碱中毒发生率、28 d死亡率比较,差异有统计学意义(P<0.05)。结论 纤维支气管镜局部灌洗治疗可有效的降低烧伤伴吸入性损伤患者血清炎症因子水平,改善患者的肺功能,减少肺部并发症的发生率。【Objective】To analyze serum inflammatory factors, pulmonary function and prognosis in patients with burn and inhalation injury by local lavage with fiberoptic bronchoscope. 【Methods】A retrospective analysis was performed on the medical records of 362 cases of burn patients with inhalation injury which met the inclusion criteria from January 2018 to December 2021.According to different treatment methods, patients were divided into fiberoptic bronchoscopic local lavage group(treatment group, n=152) and routine airway lavage group(control group, n=210). Mechanical ventilator ventilation time, ICU stay time, levels of various serum inflammatory factors, lung function indexes and arterial blood gas indexes were compared between the two groups,and the amount of fluid infusion during shock period, vital signs, adverse reactions and death at 28 days after injury before and after treatment were compared between the two groups. 【Results】The duration of mechanical ventilation and ICU stay in the treatment group were significantly shorter than those in the control group(t=61.1616, 9.3360, P<0.01). The decrease of serum Hcy, CRP and IL-6 in the treatment group was statistically significant compared with the control group(t=61.5808, 39.9392, 71.2307, P<0.05).FEV_(1), FEV_(1)/FVC and PEF in the treatment group were higher than those in the control group(t=8.0832, 17.7030, 5.6478, P<0.05).After treatment, PaO_(2) and SpO_(2) in the treatment group were higher than those in the control group(t=5.2011, P<0.05), PaCO_(2)in the treatment group was lower than that in the control group(t=8.0423, P<0.05), and total input of plasma, sodium lactate Ringer’s solution and 5% glucose injection in the treatment group were lower than those in the control group(t=20.6761, 15.7329, 4.7924,1.6739, 5.7533, 21.4817, 19.2847, 1.8496, P<0.05). After treatment, heart rate, body temperature and mean arterial pressure decreased in the two groups, and patients in the treatment group were significantly lower than those in the control group(

关 键 词：纤维支气管镜 烧伤 吸入性损伤 炎症因子 肺功能 

分 类 号：R563.1[医药卫生—呼吸系统]