纤维支气管镜吸痰灌洗联合机械排痰治疗吸入性肺炎并发呼吸衰竭疗效观察
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摘要
目的探讨纤维支气管镜吸痰灌洗联合机械排痰治疗吸入性肺炎并发呼吸衰竭的临床效果。方法选择2013年1月至2016年12月洛阳市中心医院急诊重症监护病房(EICU)收治的吸入性肺炎并发呼吸衰竭患者164例为研究对象,根据治疗方法分为观察组(n=76)和对照组(n=88),2组患者均给予控制肺部感染、纠正呼吸衰竭的常规治疗,观察组患者在常规治疗基础上给予纤维支气管镜吸痰灌洗联合机械排痰。记录2组患者的发热持续时间、机械通气时间、EICU住院时间及抗生素应用情况,分别于治疗前、治疗第5天及2周后对2组患者进行临床肺部感染评分(CPIS)和急性生理与慢性健康状况评分(APACHEⅡ),并进行临床疗效评估。结果治疗前2组患者CPIS评分及APACHEⅡ评分比较差异均无统计学意义(P>0.05)。2组患者治疗第5天和2周后CPIS评分、APACHEⅡ评分显著低于治疗前(P<0.05);2组患者治疗2周后CPIS评分、APACHEⅡ评分显著低于治疗第5天(P<0.05);观察组患者治疗第5天和2周后CPIS评分、APACHEⅡ评分显著低于对照组(P<0.05)。观察组患者发热持续时间、机械通气时间及EICU住院时间显著短于对照组(P<0.05)。观察组患者使用三联及以上抗生素患者比例显著低于对照组(χ2=18.571,P<0.05)。观察组和对照组患者治疗总有效率分别为93.42%(71/76)和81.82%(72/88),观察组患者治疗总有效率显著高于对照组(χ2=4.917,P<0.05)。结论纤维支气管镜吸痰灌洗联合机械排痰治疗吸入性肺炎并发呼吸衰竭,能够有效控制病情,改善临床症状,缩短病程,减少抗生素应用,提高治疗效果。
Objective To investigate the effect of sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration in the treatment of patients with aspiration pneumonia complicated with respiratory failure.Methods A total of 164 patients with aspiration pneumonia and respiratory failure in the Central Hospital of Luoyang City from January 2013 to December 2016 were selected as the subjects,and the patients were divided into observation group(n =76) and control group(n = 88) according to treatment method. The patients in the two groups were treated with conventional therapy to control lung infection and correct respiratory failure,and the patients in the observation group were treated with sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration on the basis of routine treatment.The duration of fever,the time of mechanical ventilation,the hospitalization time in the emergency intensive care unit(EICU)and the use of antibiotics of patients in the two groups were recorded. The patients in the two groups were assessed with clinical pulmonary infection score(CPIS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) before treatment and after five days and two weeks of treatment,and the clinical effect was evaluated. Results There was no significant difference in CPIS score and APACHE Ⅱ score between the two groups before treatment(P > 0. 05). The scores of CPIS and APACHEⅡ of the patients after five days and two weeks of treatment were significantly lower than those before treatment in the two groups(P < 0. 05). The scores of CPIS and APACHE Ⅱ of the patients after two weeks of treatment were significantly lower than those after five days of treatment in the two groups(P < 0. 05). The scores of CPIS and APACHE Ⅱ in the observation group were significantly lower than those in the control group after five days and two weeks of treatment(P < 0. 05). The duration of fever,mechanical ventilation time and EICU hospitalization time in the observation group were significantly shorter than those in the control group(P < 0. 05). The proportion of using triple and more antibiotics in the observation group was significantly lower than that in the control group(χ2= 18. 571,P < 0. 05). The total effective rate in the observation group and the control group was 93. 42%(71/76) and 81. 82%(72/88) respectively,the total effective rate in the observation group was significantly higher than that in the control group(χ2= 4. 917,P < 0. 05). Conclusion Sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration in the treatment of patients with aspiration pneumonia complicated with respiratory failure can effectively control the disease,improve the clinical symptoms,shorten the course of disease,reduce the use of antibiotics,and increase the therapeutic effect.
Objective To investigate the effect of sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration in the treatment of patients with aspiration pneumonia complicated with respiratory failure.Methods A total of 164 patients with aspiration pneumonia and respiratory failure in the Central Hospital of Luoyang City from January 2013 to December 2016 were selected as the subjects,and the patients were divided into observation group(n =76) and control group(n = 88) according to treatment method. The patients in the two groups were treated with conventional therapy to control lung infection and correct respiratory failure,and the patients in the observation group were treated with sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration on the basis of routine treatment.The duration of fever,the time of mechanical ventilation,the hospitalization time in the emergency intensive care unit(EICU)and the use of antibiotics of patients in the two groups were recorded. The patients in the two groups were assessed with clinical pulmonary infection score(CPIS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) before treatment and after five days and two weeks of treatment,and the clinical effect was evaluated. Results There was no significant difference in CPIS score and APACHE Ⅱ score between the two groups before treatment(P > 0. 05). The scores of CPIS and APACHEⅡ of the patients after five days and two weeks of treatment were significantly lower than those before treatment in the two groups(P < 0. 05). The scores of CPIS and APACHE Ⅱ of the patients after two weeks of treatment were significantly lower than those after five days of treatment in the two groups(P < 0. 05). The scores of CPIS and APACHE Ⅱ in the observation group were significantly lower than those in the control group after five days and two weeks of treatment(P < 0. 05). The duration of fever,mechanical ventilation time and EICU hospitalization time in the observation group were significantly shorter than those in the control group(P < 0. 05). The proportion of using triple and more antibiotics in the observation group was significantly lower than that in the control group(χ2= 18. 571,P < 0. 05). The total effective rate in the observation group and the control group was 93. 42%(71/76) and 81. 82%(72/88) respectively,the total effective rate in the observation group was significantly higher than that in the control group(χ2= 4. 917,P < 0. 05). Conclusion Sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration in the treatment of patients with aspiration pneumonia complicated with respiratory failure can effectively control the disease,improve the clinical symptoms,shorten the course of disease,reduce the use of antibiotics,and increase the therapeutic effect.
引文
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[5]韩立红,祝坤.PCT和CPIS对老年CAP预后的评估价值[J].临床肺科杂志,2014,19(4):673-675.
[6]王胜云,陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学,2015,27(2):97-101.
[7]ALVAREZ LERMA F.Efficacy of meropenem as monotherapy in the treatment of ventilator-associated pneumonia[J].J Chemother,2001,13(1):70-81.
[8]INTERNATIONAL C.Special issue:the Japanese respiratory society guidelines for the management of hospital-acquired pneumonia in adults[J].Respirology,2009,14(Suppl 2):S1-S71.
[9]陆芹芹,李培杰,王晓琴,等.吸入性肺炎生物学标志物的研究[J].东南大学学报(医学版),2015,34(4):648-652.
[10]SUN T,SUN L,WANG R,et al.Clinical efficacy and safety of moxifloxacin versus levofloxacin plus metronidazole for community-acquired pneumonia with aspiration factors[J].Chin Med J,2014,127(7):1201-1205.
[11]YAMASAKI K,KAWANAMI T,YATERA K,et al.Significance of anaerobes and oral bacteria in community-acquired pneumonia[J].PLo S One,2013,8(5):e63103.
[12]中华人民共和国国家卫生和计划生育委员会.国家卫生计生委办公厅关于印发三级综合医院医疗服务能力指南(2016年版)的通知:国卫办医函[2016]936号[A/OL].(2016-08-29)[2016-10-18].http://http://www.nhfpc.gov.cn/yzygj/s3594q/201610/6e6780e8b7c24c57bf386d35e9f952df.shtml.
[13]李莲花,杨倩,栾禹博,等.T细胞亚群与临床肺部感染评分在老年院内获得性肺炎预后评价中的作用[J].中华急诊医学杂志,2014,23(4):377-381.
[14]范兆普,赵雪峰.降钙素原与临床肺部感染评分在呼吸机相关性肺炎预后评估中的价值[J].临床肺科杂志,2015,20(6):1083-1085.
[15]任艺,邵旦兵,刘红梅,等.三种不同评分在急诊危重患者预后评估中的对比研究[J].中华急诊医学杂志,2014,23(1):71-74.
[16]张亮,刘万周,程涛.降钙素原和急性生理与慢性健康评分Ⅱ对脓毒症患者预后的评估[J].新乡医学院学报,2016,33(7):629-631.
[2]ARDS DEFINITION TASK FORCE,RANIERI V M,RUBENFELD G D,et al.Acute respiratory distress syndrome:the berlin definition[J].JAMA,2012,307(23):2526-2533.
[3]KOMIYA K,ISHII H,KADOTA J.Healthcare-associated pneumonia and aspiration pneumonia[J].Aging Dis,2014,6(1):27-37.
[4]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南:2016年版[J].中华结核和呼吸杂志,2016,39(4):253-279.
[5]韩立红,祝坤.PCT和CPIS对老年CAP预后的评估价值[J].临床肺科杂志,2014,19(4):673-675.
[6]王胜云,陈德昌.降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J].中华危重病急救医学,2015,27(2):97-101.
[7]ALVAREZ LERMA F.Efficacy of meropenem as monotherapy in the treatment of ventilator-associated pneumonia[J].J Chemother,2001,13(1):70-81.
[8]INTERNATIONAL C.Special issue:the Japanese respiratory society guidelines for the management of hospital-acquired pneumonia in adults[J].Respirology,2009,14(Suppl 2):S1-S71.
[9]陆芹芹,李培杰,王晓琴,等.吸入性肺炎生物学标志物的研究[J].东南大学学报(医学版),2015,34(4):648-652.
[10]SUN T,SUN L,WANG R,et al.Clinical efficacy and safety of moxifloxacin versus levofloxacin plus metronidazole for community-acquired pneumonia with aspiration factors[J].Chin Med J,2014,127(7):1201-1205.
[11]YAMASAKI K,KAWANAMI T,YATERA K,et al.Significance of anaerobes and oral bacteria in community-acquired pneumonia[J].PLo S One,2013,8(5):e63103.
[12]中华人民共和国国家卫生和计划生育委员会.国家卫生计生委办公厅关于印发三级综合医院医疗服务能力指南(2016年版)的通知:国卫办医函[2016]936号[A/OL].(2016-08-29)[2016-10-18].http://http://www.nhfpc.gov.cn/yzygj/s3594q/201610/6e6780e8b7c24c57bf386d35e9f952df.shtml.
[13]李莲花,杨倩,栾禹博,等.T细胞亚群与临床肺部感染评分在老年院内获得性肺炎预后评价中的作用[J].中华急诊医学杂志,2014,23(4):377-381.
[14]范兆普,赵雪峰.降钙素原与临床肺部感染评分在呼吸机相关性肺炎预后评估中的价值[J].临床肺科杂志,2015,20(6):1083-1085.
[15]任艺,邵旦兵,刘红梅,等.三种不同评分在急诊危重患者预后评估中的对比研究[J].中华急诊医学杂志,2014,23(1):71-74.
[16]张亮,刘万周,程涛.降钙素原和急性生理与慢性健康评分Ⅱ对脓毒症患者预后的评估[J].新乡医学院学报,2016,33(7):629-631.