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机械通气联合纤维支气管肺泡灌洗治疗重症肺部感染的临床疗效及安全性。

Clinical Efficacy and Safety of Mechanical Ventilation Combined with Fiberoptic Bronchoalveolar Lavage in Patients with Severe Pulmonary Infection.

机构信息

Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China (mainland).

Department of Critic Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China (mainland).

出版信息

Med Sci Monit. 2019 Jul 21;25:5401-5407. doi: 10.12659/MSM.915507.

Abstract

BACKGROUND The aim of this study was to assess the clinical efficacy and safety of mechanical ventilation combined with fiberoptic bronchoalveolar lavage in patients with severe pulmonary infection. MATERIAL AND METHODS We randomly divided 81 patients with severe pulmonary infection into a control group (n=40) and an observation group (n=41). Both groups were treated using mechanical ventilation, and observation group additionally received assistive fiberoptic bronchoalveolar lavage. RESULTS The cure rate and effectiveness rate in the observation group were higher than in the control group (P<0.05, χ²=3.2), and the incidence of ventilator-associated pneumonia in the observation group was significantly lower than that in the control group (P<0.05, χ²=9.4). The partial pressure of oxygen (PaO₂) and oxygen saturation (SaO₂) were higher in the observation group than in the control group (P<0.05, t=3.862, t=33.595), whereas the partial pressure of carbon dioxide (PaCO₂) and respiratory rate were lower in the observation group than in the control group (P<0.05, t=3.307, t=5.043). The levels of C-reactive protein (CRP), tumor necrosis factor-a (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) in the 2 groups were lower after treatment than before treatment (all P<0.05), and the levels in the observation group were lower than those in the control group (all P<0.05). Hospital stay, infection control window appearance time, invasive mechanical ventilation time, and total mechanical ventilation time in the observation group were shorter than those in the control group (P<0.05, t=13.990, t=8.643, t=9.717, t=8.980). CONCLUSIONS Mechanical ventilation combined with fiberoptic bronchoalveolar lavage can effectively improve the curative effects and the blood gas and inflammation indicators in patients.

摘要

背景

本研究旨在评估机械通气联合纤维支气管镜肺泡灌洗在重症肺部感染患者中的临床疗效和安全性。

材料与方法

将 81 例重症肺部感染患者随机分为对照组(n=40)和观察组(n=41)。两组均采用机械通气治疗,观察组在此基础上辅助纤维支气管镜肺泡灌洗。

结果

观察组的治愈率和有效率均高于对照组(P<0.05,χ²=3.2),观察组呼吸机相关性肺炎的发生率明显低于对照组(P<0.05,χ²=9.4)。观察组的氧分压(PaO₂)和氧饱和度(SaO₂)均高于对照组(P<0.05,t=3.862,t=33.595),而观察组的二氧化碳分压(PaCO₂)和呼吸频率均低于对照组(P<0.05,t=3.307,t=5.043)。两组治疗后 C 反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)水平均低于治疗前(均 P<0.05),且观察组低于对照组(均 P<0.05)。观察组的住院时间、感染控制窗口出现时间、有创机械通气时间和总机械通气时间均短于对照组(均 P<0.05,t=13.990,t=8.643,t=9.717,t=8.980)。

结论

机械通气联合纤维支气管镜肺泡灌洗可有效提高重症肺部感染患者的疗效,并改善血气及炎症指标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa16/6664828/ae4b808d874f/medscimonit-25-5401-g001.jpg

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