胸部CT定位后纤维支气管镜气道灌洗在机械通气并发重症肺炎患者中的应用效果

发布时间：2018-08-18 20:49

【摘要】：目的探讨CT定位下采用纤维支气管镜气道灌洗对机械通气并发重症肺炎的临床疗效。方法选择2012年3月-2014年9月于该院治疗的机械通气合并重症肺部感染者86例为研究对象。将患者随机分为对照组和观察组,每组43例,对照组患者在支气管镜灌洗前未做肺部影像学检查,观察组患者在气道灌洗前给与CT检查。监测患者呼吸频率、心率及血压等生命体征,灌洗前和灌洗后1 h的呼吸力学指标,并评价两组患者的临床疗效。结果观察组患者灌洗中及灌洗后10 min的呼吸频率及心率均明显低于对照组(P0.05),血压差异无统计学意义(P0.05)。观察组患者灌洗后1 h气道峰压(PIP)、吸气阻力(RAW)及呼吸功(WOBvent)均低于对照组(P0.05),肺动态顺应性(Cdyn)明显高于对照组(P0.05)。观察组患者治疗总有效率为97.67%;明显高于对照组患者治疗效有效率86.05%,差异有统计学意义(P0.05)。结论采用胸部CT定位下纤维支气管镜气道灌洗,能够有效降低患者的应激反应、减轻气道高反应性,缩短机械通气及抗生素使用时间,提高临床疗效。
[Abstract]:Objective to investigate the clinical effect of bronchofiberscope airway lavage under CT localization on mechanical ventilation complicated with severe pneumonia. Methods 86 patients with severe pulmonary infection who were treated in our hospital from March 2012 to September 2014 were selected. The patients were randomly divided into control group (n = 43) and observation group (n = 43). The patients in the control group were not examined with lung imaging before bronchoscope lavage, and the patients in the observation group were given CT examination before airway lavage. The vital signs such as respiratory frequency heart rate and blood pressure were monitored and the respiratory mechanical indexes before and 1 hour after lavage were measured and the clinical efficacy of the two groups was evaluated. Results the respiratory frequency and heart rate in the observation group were significantly lower than those in the control group during and 10 min after lavage (P0.05), but there was no significant difference in blood pressure (P0.05). The peak airway pressure (PIP),) inspiratory resistance (RAW) and respiratory work (WOBvent) were significantly lower in the observation group than those in the control group at 1 h after lavage (P0.05), and the pulmonary dynamic compliance (Cdyn) was significantly higher than that in the control group (P0.05). The total effective rate of treatment in the observation group was 97.67; significantly higher than that in the control group 86.05, the difference was statistically significant (P0.05). Conclusion Airway lavage with fiberoptic bronchoscope under chest CT orientation can effectively reduce the stress response, reduce airway hyperresponsiveness, shorten the time of mechanical ventilation and antibiotic use, and improve the clinical efficacy.
【作者单位】：四川省绵阳市中心医院呼吸内科;
【分类号】：R563.1;R816.41

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