支气管镜下给药对重症肺炎者的临床疗效分析
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摘要
目的探究支气管镜下给药对重症肺炎的临床疗效。方法选取80例重症肺炎患者随机分为对照组及观察组,各40例。对照组进行常规抗感染、吸痰治疗,观察组在对照组治疗的基础上,联合支气管镜下给药治疗。治疗1 w后,比较两组临床症状改善情况以及治疗前后两组动脉血气分析指标、白细胞计数(WBC)及血清C反应蛋白(CRP)变化。结果治疗后1 w,两组肺部感染评分(CPIS)均较治疗前降低(P <0.01),且观察组退热时间、机械通气时间较对照组缩短(P <0.01),CPIS均较对照组降低(P <0.01)。与治疗前比较,治疗后1 w,两组动脉血氧分压(PaO2)和动脉血氧饱和度(SpO2)升高,动脉血二氧化碳分压(PaCO2)均降低(P <0.01),但两组间SpO2和Pa O2比较无显著性差异(P> 0.05),而观察组PaCO2低于对照组(P <0.01);治疗后1 w,两组WBC及血清CRP水平均降低(P <0.01),且观察组均低于对照组(P <0.01)。结论支气管镜下给药可显著缓解重症肺炎患者临床症状,有效改善其血气分析指标,抑制炎症反应,疗效优于常规治疗。
Objective To explore the clinical effects of bronchoscopic administration on the patients with severe pneumonia.Methods A total of 80 patients with severe pneumonia were selected and randomly divided into a control group and an observation group(n=40, respectively). The control group received routine anti-infection and sputum aspiration therapy, and the observation group additionally received bronchoscopic administration. One week after the treatment, the improvement of clinical symptoms and the changes in the arterial blood gas analysis index, white blood cell count(WBC) and serum c-reactive protein(CRP) before and after the treatment between the two groups were compared. Results One week after the treatment, the pulmonary infection scores(CPIS)were lower than those before the treatment(P < 0.01), and the duration of heat treatment and mechanical ventilation in the observation group was shorter than that in the control group(P < 0.01); CPIS was lower than that in the control group(P < 0.01). Compared with the values before the treatment, the arterial partial pressure of oxygen(PaO_2) and arterial oxygen saturation(SpO_2) increased one week after the treatment, but arterial carbon dioxide partial pressure(PaCO_2) decreased(P < 0.01); there was no significant difference in the SpO_2 and PaO_2 between the two groups(P > 0.05), and the PaCO_2 in the observation group was lower than that in the control group(P < 0.01). One week after the treatment, the WBC and serum CRP levels in the two groups decreased(P < 0.01), and the values in the observation group were lower than those in the control group(P < 0.01). Conclusion Bronchoscopic administration can significantly relieve the patients with severe pneumonia, effectively improve their blood gas analysis indicators and inhibit inflammatory reactions; the effects are better than those of conventional therapy.
Objective To explore the clinical effects of bronchoscopic administration on the patients with severe pneumonia.Methods A total of 80 patients with severe pneumonia were selected and randomly divided into a control group and an observation group(n=40, respectively). The control group received routine anti-infection and sputum aspiration therapy, and the observation group additionally received bronchoscopic administration. One week after the treatment, the improvement of clinical symptoms and the changes in the arterial blood gas analysis index, white blood cell count(WBC) and serum c-reactive protein(CRP) before and after the treatment between the two groups were compared. Results One week after the treatment, the pulmonary infection scores(CPIS)were lower than those before the treatment(P < 0.01), and the duration of heat treatment and mechanical ventilation in the observation group was shorter than that in the control group(P < 0.01); CPIS was lower than that in the control group(P < 0.01). Compared with the values before the treatment, the arterial partial pressure of oxygen(PaO_2) and arterial oxygen saturation(SpO_2) increased one week after the treatment, but arterial carbon dioxide partial pressure(PaCO_2) decreased(P < 0.01); there was no significant difference in the SpO_2 and PaO_2 between the two groups(P > 0.05), and the PaCO_2 in the observation group was lower than that in the control group(P < 0.01). One week after the treatment, the WBC and serum CRP levels in the two groups decreased(P < 0.01), and the values in the observation group were lower than those in the control group(P < 0.01). Conclusion Bronchoscopic administration can significantly relieve the patients with severe pneumonia, effectively improve their blood gas analysis indicators and inhibit inflammatory reactions; the effects are better than those of conventional therapy.
引文
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[3]胡华元,陈静波,陈涛.重症肺炎经纤维支支气管镜支气管肺泡灌洗治疗临床研究[J].临床医学工程, 2013, 20(11):1371-1372.
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[7]李丽娟,彭夫松,陈炜,等.大剂量盐酸氨溴索联合纤维支支气管镜灌洗治疗老年重症肺炎的临床研究[J].海南医学, 2013, 24(4):495-497.
[8]沈锋,刘媛怡,刘颖,等.经纤维支支气管镜引导吸痰治疗4例重症肺炎[J].贵阳医学院学报, 2012, 37(1):101-102.
[9] Liu N, Pruszkowski O, Leroy JE, et al. Administration automatique du propofol et du rémifentanil selon l'indice bispectral pendant des bronchoscopes rigides:uneétude randomisée[J]. Canadian Journal of Anesthesia/journal Canadien Danesthésie, 2013, 60(9):881-887.
[10]武光瑞.盐酸氨溴索联合支气管镜灌洗对重症肺部感染患者血气分析的影响[J].河南医学研究, 2016, 25(1):117-118.
[2]汤铭阁,葛志军,陆俊杰.重症肺炎治疗进展[J].河北医药, 2016,38(8):1247-1249.
[3]胡华元,陈静波,陈涛.重症肺炎经纤维支支气管镜支气管肺泡灌洗治疗临床研究[J].临床医学工程, 2013, 20(11):1371-1372.
[4]胡皓夫.重症肺炎的诊断与治疗[J].中外医学研究, 2012, 23(33):408-410.
[5]洪军,陈敏华.临床肺部感染评分评估呼吸机相关性肺炎预后的研究[J].中国呼吸与危重监护杂志, 2011, 10(3):289-291.
[6] Scala R, Naldi M, Maccari U. Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia[J]. Critical Care, 2010, 14(2):1-12.
[7]李丽娟,彭夫松,陈炜,等.大剂量盐酸氨溴索联合纤维支支气管镜灌洗治疗老年重症肺炎的临床研究[J].海南医学, 2013, 24(4):495-497.
[8]沈锋,刘媛怡,刘颖,等.经纤维支支气管镜引导吸痰治疗4例重症肺炎[J].贵阳医学院学报, 2012, 37(1):101-102.
[9] Liu N, Pruszkowski O, Leroy JE, et al. Administration automatique du propofol et du rémifentanil selon l'indice bispectral pendant des bronchoscopes rigides:uneétude randomisée[J]. Canadian Journal of Anesthesia/journal Canadien Danesthésie, 2013, 60(9):881-887.
[10]武光瑞.盐酸氨溴索联合支气管镜灌洗对重症肺部感染患者血气分析的影响[J].河南医学研究, 2016, 25(1):117-118.