支气管肺泡灌洗术对卒中并发重症肺炎患者的作用

发布时间：2018-10-16 16:52

【摘要】：目的探讨支气管肺泡灌洗术(BAL)对卒中机械通气并发重症肺炎患者的治疗效果。方法前瞻性纳入2012年1月至2015年12月收治的68例接受有创机械通气的卒中并发重症肺炎患者,按照随机数字表分为研究组(34例)和对照组(34例),对照组采取治疗原发病、抗感染、常规吸痰、机械辅助排痰及对症支持等治疗,研究组在对照组基础上加用纤维支气管镜(以下简称纤支镜)行BAL治疗,比较两组患者治疗前和治疗后3 d氧合指数、气道峰压的变化、治疗前痰细菌培养阳性率和治疗后7 d痰细菌培养转阴率、抗生素使用时间、机械通气时间及平均重症监护室(ICU)住院时间等指标。结果 (1)研究组和对照组治疗前氧合指数、气道峰压比较[氧合指数:(148±31)比(151±29),气道峰压:(32±5)cm H_2O比(31±5)cm H_2O,t值分别为0.35和0.38],差异无统计学意义(均P0.05),治疗后3 d,研究组氧合指数升高较对照组更为明显[(213±22)比(186±25)],差异有统计学意义(t=4.70,P0.01),但两组间气道峰压比较[(21±4)cm H_2O比(22±5)cm H_2O],差异无统计学意义(t=0.96,P0.05);(2)研究组治疗前痰细菌培养阳性率和治疗后7 d痰细菌培养转阴率明显高于对照组[痰细菌培养阳性率:82.4%(28/34)比47.1%(16/34),治疗7 d后痰细菌培养转阴率89.3%(25/28)比56.2%(9/16),差异均有统计学意义(χ2值分别为9.27和5.01,均P0.05);(3)研究组抗生素使用时间、机械通气时间及平均ICU住院时间与对照组相比,均明显降低[抗生素使用时间:(9±3)d比(13±3)d、机械通气时间:(13±3)d比(17±3)d、平均ICU住院时间:(17±6)d比(22±6)d],差异均有统计学意义(t值分别为4.74、5.17、4.21,均P0.01)。结论对机械通气的卒中并发重症肺炎患者行BAL治疗,能提高氧合指数和痰标本转阴检出率、减少使用抗生素、机械通气及平均ICU住院时间。
[Abstract]:Objective to investigate the effect of bronchoalveolar lavage (BAL) on patients with severe pneumonia after mechanical ventilation. Methods from January 2012 to December 2015, 68 stroke patients with severe pneumonia who received invasive mechanical ventilation were prospectively divided into study group (n = 34) and control group (n = 34). Anti-infection, routine sputum aspiration, mechanically assisted sputum drainage and symptomatic support were used in the study group. The patients in the study group were treated with bronchofiberscope (BAL) on the basis of the control group. The oxygenation index was compared between the two groups before and 3 days after treatment. The change of peak airway pressure, the positive rate of sputum bacteria culture before treatment, the negative rate of sputum bacteria culture 7 days after treatment, the time of using antibiotics, the time of mechanical ventilation and the average hospitalization time of (ICU) in intensive care unit. Results (1) the oxygenation index of the study group and the control group before treatment, Peak airway pressure [oxygenation index: (148 卤31) vs (151 卤29), peak airway pressure: (32 卤5) cm / H _ 2O = (31 卤5) cm H _ 2O _ 2], there was no significant difference (P0.05). 3 days after treatment, the increase of oxygenation index in the study group was more obvious than that in the control group [(213 卤22) vs (186 卤25)]. There was no significant difference between the two groups [(21 卤4) cm H _ 2O / (22 卤5) cm H _ 2O]. The positive rate of sputum bacterial culture before treatment and the negative rate of sputum bacterial culture at 7 days after treatment in the study group were significantly higher than those in the control group [(22 卤5) cm H _ 2O] (t0. 966% P0.05); (2), but the positive rate of sputum bacterial culture in the study group was significantly higher than that in the control group [(21 卤4) cm H _ 2O / (22 卤5) cm H _ 2O]. The positive rates were 82.4% (28 / 34) vs 47.1% (16 / 34), 89.3% (25 / 28) vs 56.2% (9 / 16) of sputum bacteria culture after 7 days treatment. The differences were statistically significant (蠂 ~ 2 = 9.27 and 5.01, respectively, P0.05); (3). Compared with the control group, the mechanical ventilation time and average ICU hospitalization time were significantly lower [antibiotic use time: (9 卤3) days vs (13 卤3) days, mechanical ventilation time: (13 卤3) days vs (17 卤3) days, mean ICU hospitalization time: (17 卤6) days vs (22 卤6) days], the difference was statistically significant (t = 4.745.174.21, P < 0.01). Conclusion BAL treatment for patients with severe pneumonia after mechanical ventilation can improve oxygenation index and sputum negative detection rate, reduce the use of antibiotics, mechanical ventilation and average ICU hospitalization time.
【作者单位】：广州市红十字会医院暨南大学医学院附属广州红十字会医院中心重症监护室;
【基金】：广东省自然科学基金(2015A030313735) 广东省科技计划项目(2014A020212651)
【分类号】：R743.3;R563.1

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