支气管镜肺泡灌洗对重症肺炎患者的治疗效果分析  

Analysis of the Therapeutic Effect of Broncho-Alveolar Lavage on Severe Pneumonia

作　　者：杨宁 姚瑶 辛瑞夏 刘慧莹 白赟彪 Yang Ning;Yao Yao;Xin Ruixia;Liu Huiying;Bai Yunbiao(Department of Respiratory and Critical Care Medicine,Fifth Medical Center,General Hospital of the People's Liberation Army,Beijing 100071,China)

机构地区：[1]解放军总医院第五医学中心呼吸与危重症医学科,北京100071

出　　处：《成都医学院学报》2025年第2期246-249,255,共5页Journal of Chengdu Medical College

基　　金：北京市自然科学基金-海淀原始创新联合基金资助项目(No:L232125)。

摘　　要：目的探究支气管镜肺泡灌洗联合物理疗法对重症肺炎患者的临床疗效。方法选取2021年1月至2024年5月北京市某医学中心收治的重症肺炎患者为研究对象,根据治疗方法不同将其分为对照组和联合组,排除混杂因素匹配后每组纳入患者148例,对照组予以基础治疗和物理治疗,联合组在对照组基础上加用支气管镜肺泡灌洗治疗。比较两组临床疗效和临床症状改善时间、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、临床肺部感染(CPIS)评分、Murray肺损伤评分(MLIS)、动脉血气指标、血乳酸(LAC)、炎症指标水平[白介素-1β(IL-1β)、IL-6和肿瘤坏死因子-α(TNF-α)]差异,观察两组在治疗期间的并发症发生情况。结果治疗期间,联合组退热时间、血象恢复正常时间、肺部炎症吸收时间、住院时间均低于对照组(P<0.05)。治疗7 d后,联合组治疗总有效率(71.62%)高于对照组(60.14%)(P<0.05);两组APACHEⅡ、CPIS、MLIS评分均降低(P<0.05),且联合组各评分较对照组更低(P<0.05);两组PaO_(2)/FiO2、动静脉血氧分压差和LAC水平均改善(P<0.05),且联合组较对照组改善更明显(P<0.05);两组IL-1β、IL-6、TNF-α水平均降低(P<0.05),且联合组较对照组更低(P<0.05)。治疗期间两组并发症发生率比较,差异无统计学意义(P>0.05)。结论支气管镜肺泡灌洗联合物理疗法治疗重症肺炎疗效明显,能减少患者临床症状改善时间,降低炎症因子水平,改善动脉血气指标水平。Objective To explore the clinical effect of broncho-alveolar lavage(BAL)combined with physical therapy on patients with severe pneumonia.Methods Patients with severe pneumonia admitted to a medical center in Beijing from January 2021 to May 2024 were selected as the study subjects.According to different treatment methods,they were divided into a control group and a combined group,with 148 patients in each group after excluding confounding factors and matching.The control group was given basic treatment and physical treatment,while the combined group was additionally given BAL on the basis of the treatment performed in the control group.The clinical efficacy and clinical symptom improvement time,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,clinical pulmonary infection score(CPIS),Murray lung injury score(MLIS),arterial blood gas indexes,blood lactic acid(LAC),inflammatory indexes[interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α)]were compared between the two groups.And the complications in the two groups during treatment were observed.Results During treatment,the time of fever abatement,time of hemogram return to normal,time of lung inflammation absorption and hospital stay in the combined group were shorter than those in the control group(P<0.05).After 7 d of treatment,the total effective rate of treatment in the combined group(71.62%)was higher than that in the control group(60.14%)(P<0.05).The APACHEⅡscore,CPIS and MLIS in both groups were decreased after 7 d of treatment(P<0.05),and the above scores in the combined group were lower than those in the control group(P<0.05).After 7 d of treatment,partial pressure of carbon dioxide/fraction of inspired oxygen(PaO_(2)/FiO 2),arteriovenous O 2 difference and LAC levels were improved in both groups(P<0.05),and the improvement was more pronounced in the combined group compared to the control group(P<0.05).After 7 d of treatment,the levels of IL-1β,IL-6 and TNF-αwere reduced in both groups(P<0.05),and the levels in the combined group we

关 键 词：支气管镜肺泡灌洗 物理疗法 重症肺炎 炎症因子 

分 类 号：R563.1[医药卫生—呼吸系统]