Liu D, Lian H, Wang J, Li X, Zhao Q, You Q
Department of Gastroenterology, Affiliated Hospital of Jiangnan University, the Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China -
Minerva Med. 2015 Apr;106(2):79-86. Epub 2014 Dec 17.
The aim of this paper was to investigate the methodology and clinical efficacy of early bundle therapy for complicated moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer.
A prospective study was conducted to analyze the clinical data from 49 patients who developed complicated moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer. Among them, 27 patients underwent a bundle therapy-tracheostomy followed by ventilator-assisted breathing with reverse trendelenburg position, early goal-directed hemodynamic support, enteral nutrition by nasointestinal tube, effective antibiotic usage and large doses of expectorants in addition to the conventional treatments. The remaining 22 patients underwent conventional treatment (controls). The hospital fatality rates, incidence of serious complications, mechanical ventilation time and ICU length of stay of the two groups were compared.
Patients in the bundle therapy group had higher cure rate of pneumonia than the control group (P=0.041), significantly lower fatality rate than the controls (P=0.005), lower incidence of complications than the controls (P<0.05), shorter ICU length of stay than the control group (P=0.017), significantly shorter mechanical ventilation time (P=0.032), lower Acute Physiology and Chronic Health Evaluation II Score (P=0.036) and lower Clinical Pulmonary Infection Score (P=0.047).
Early bundle therapy can effectively improve the treatment efficacy for moderate to severe aspiration pneumonia after cervical esophagogastrostomy for esophageal cancer.
本文旨在探讨食管癌颈段食管胃吻合术后并发中重度吸入性肺炎的早期集束化治疗方法及临床疗效。
进行一项前瞻性研究，分析49例食管癌颈段食管胃吻合术后并发中重度吸入性肺炎患者的临床资料。其中，27例患者接受集束化治疗——气管切开术，随后采用头高脚低位进行机械通气支持、早期目标导向血流动力学支持、经鼻肠管肠内营养、有效使用抗生素及大剂量祛痰药，同时给予常规治疗。其余22例患者接受常规治疗（对照组）。比较两组的医院死亡率、严重并发症发生率、机械通气时间及重症监护病房住院时间。
集束化治疗组患者肺炎治愈率高于对照组（P = 0.041），死亡率显著低于对照组（P = 0.005），并发症发生率低于对照组（P < 0.05），重症监护病房住院时间短于对照组（P = 0.017），机械通气时间显著缩短（P = 0.032），急性生理与慢性健康状况评分II较低（P = 0.036），临床肺部感染评分较低（P = 0.047）。
早期集束化治疗可有效提高食管癌颈段食管胃吻合术后中重度吸入性肺炎的治疗效果。
