乙酰半胱氨酸局部注入在重症肺炎患者纤维支气管镜肺泡灌洗治疗中的应用效果  

Effectiveness of local injection with acetylcysteine in fiberoptic bronchoscopic alveolar lavage therapy of patients with severe pneumonia

作　　者：陈芳[1] 尹丽花 CHEN Fang;YIN Lihua(Changsha Center Hospital Affiliated to University of South China,Changsha 410004,China)

机构地区：[1]南华大学附属长沙中心医院,长沙市410004

出　　处：《临床合理用药杂志》2024年第15期1-3,7,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 观察乙酰半胱氨酸局部注入在重症肺炎患者纤维支气管镜肺泡灌洗治疗中的应用效果。方法 选取2021年1月—2022年12月南华大学附属长沙中心医院收治的重症肺炎患者82例,采用随机数字表法分为布地奈德组与乙酰半胱氨酸组,各41例。患者均采用纤维支气管镜肺泡灌洗治疗,其中布地奈德组患者联合布地奈德雾化吸入治疗,乙酰半胱氨酸组患者联合乙酰半胱氨酸局部注入治疗,2组均持续治疗2周。比较2组临床疗效,治疗前后肺功能指标、细胞因子、免疫指标,不良反应。结果 乙酰半胱氨酸组总有效率为92.68%,高于布地奈德组的70.73%(χ^(2)=6.609,P=0.010)。治疗2周后,2组第1秒用力呼气容积、呼气流量峰值、第1秒用力呼气容积与用力肺活量比值高于治疗前,且乙酰半胱氨酸组高于布地奈德组(P<0.01);2组血清肿瘤坏死因子-α、白介素-4、C反应蛋白水平及白细胞计数较治疗前降低,血清免疫球蛋白(Ig)A、IgG、IgM水平较治疗前升高,且乙酰半胱氨酸组低/高于布地奈德组(P<0.05或P<0.01)。布地奈德组与乙酰半胱氨酸组不良反应总发生率比较,差异无统计学意义(14.63%vs. 17.07%,χ^(2)=0.091,P=0.762)。结论 重症肺炎患者在纤维支气管镜肺泡灌洗治疗中应用乙酰半胱氨酸局部注入可增强疗效,显著提高患者肺功能,减轻机体炎性反应,改善免疫功能,且用药安全性较高。Objective To observe the effectiveness of local injection with acetylcysteine in fiberoptic bronchoscopic alveolar lavage therapy of patients with severe pneumonia.Methods Eighty-two patients with severe pneumonia admitted to Changsha Center Hospital Affiliated to University of South China from January 2021 to December 2022 were selected,and they were divided into the budesonide group and the acetylcysteine group by random number table method,with 41 cases in each group.All patients were treated with fiberoptic bronchoscopic alveolar lavage,in which patients in the budesonide group were combined with budesonide aerosol inhalation therapy,and patients in the acetylcysteine group were combined with local injection of acetylcysteine,and both groups continued to be treated for 2 weeks.Clinical efficacy,and pulmonary function indexes,cytokines and immune indexes before and after treatment were compared between the two groups,and adverse reactions in the two groups were observed.Results The total effective rate in the acetylcysteine group was 92.68%,which was higher than 70.73%in the budesonide group(χ^(2)=6.609,P=0.010).After 2 weeks of treatment,FEV_(1),PEF and FEV_(1)/FVC of the two groups were higher than those before treatment,and the acetylcysteine group were higher than those in the budesonide group(P<0.01);Serum TNF-α,IL-4,CRP levels and WBC of the two groups were lower than those before treatment,and serum IgA,IgG and IgM levels were higher than those before treatment,and the indexes in the acetylcysteine group were lower/higher than those in the budesonide group(P<0.05 or P<0.01).There was no statistically significant difference in the total incidence of adverse reactions between the budesonide group and the acetylcysteine group(14.63%vs.17.07%,χ^(2)=0.091,P=0.762).Conclusion The application of local injection with acetylcysteine in fiberoptic bronchoscopic alveolar lavage therapy for patients with severe pneumonia can enhance the efficacy,it can significantly improve the pulmonary function of patients,red

关 键 词：重症肺炎 乙酰半胱氨酸 布地奈德 纤维支气管镜肺泡灌洗 治疗结果 

分 类 号：R563.1[医药卫生—呼吸系统]