纤维支气管镜肺泡灌洗治疗重症肺炎的临床效果及其对肺通气功能、血清炎性因子水平的影响
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摘要
目的观察纤维支气管镜肺泡灌洗治疗重症肺炎的临床效果,并探讨其对肺通气功能、血清炎性因子水平的影响。方法选取2017年1月—2018年4月丹江口市第一医院收治的重症肺炎患者73例,根据治疗方法分为对照组34例和观察组39例。对照组患者给予常规治疗,观察组患者在常规治疗基础上给予纤维支气管镜肺泡灌洗治疗。比较两组患者临床效果,临床症状及体征消退/消失时间、感染控制时间及住院时间,治疗前及治疗后4、7 d肺通气功能指标、血清炎性因子水平。结果观察组患者临床效果优于对照组(P<0.05)。观察组患者发热消退时间、咳嗽咳痰消失时间、湿啰音消失时间、感染控制时间及住院时间短于对照组(P<0.05)。治疗前两组患者氧合指数(OI)、肺动态顺应性(Cdyn)、呼吸做功(WOB)比较,差异无统计学意义(P>0.05);治疗后4、7 d观察组患者OI、Cdyn高于对照组,WOB少于对照组(P<0.05)。治疗前两组患者血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、白介素8(IL-8)水平比较,差异无统计学意义(P>0.05);治疗后4、7 d观察组患者血清TNF-α、IL-6、IL-8水平低于对照组(P<0.05)。结论纤维支气管镜肺泡灌洗治疗重症肺炎的临床效果确切,可有效缩短临床症状及体征改善时间、感染控制时间及住院时间,改善肺通气功能,降低血清炎性因子水平,有利于减轻炎性反应。
Objective To observe the clinical effect of fiberoptic bronchoscopic alveolar lavage on severe pneumonia,to investigate the impact on pulmonary ventilation function and serum inflammatory cytokines levels. Methods A total of 73 patients with severe pneumonia were selected in the First Hospital of Danjiangkou from January 2017 to April 2018,and they were divided into control group(n=34)and observation group(n=39)according to therapeutic methods. Patients in control group received conventional treatment,while patients in observation group received fiberoptic bronchoscopic alveolar lavage based on conventional treatment. Clinical effect,subsidence/disappearance time of clinical symptoms and signs,control time of infection,hospital stays,index of pulmonary ventilation function and serum inflammatory cytokines levels before treatment,4 and 7 days after treatment were compared between the two groups. Results Clinical effect in observation group was statistically significantly better than that in control group(P<0.05). Disappearance time of fever,cough and expectoration,moist rale,control time of infection and hospital stays in observation group were statistically significantly shorter than those in control group(P<0.05). No statistically significant differences of OI,Cdyn or WOB was found between the two groups before treatment(P>0.05);4 and 7 days after treatment,OI and Cdyn in observation group were statistically significantly higher than those in control group,while WOB in observation group was statistically significantly lower than that in control group,respectively(P<0.05). No statistically significant differences of serum level of TNF-α,IL-6 or IL-8 was found between the two groups before treatment(P>0.05),while serum levels of TNF-α,IL-6 and IL-8 in observation group were statistically significantly lower than those in control group 4 and 7 days after treatment(P<0.05). Conclusion Fiberoptic bronchoscopic alveolar lavage has certain clinical effect in treating severe pneumonia,can effectively shorten the improvement time of clinical symptoms and signs, control time of infection,improve the pulmonary ventilation function and reduce the serum inflammatory cytokines levels,is helpful to relieve the inflammatory reaction.
Objective To observe the clinical effect of fiberoptic bronchoscopic alveolar lavage on severe pneumonia,to investigate the impact on pulmonary ventilation function and serum inflammatory cytokines levels. Methods A total of 73 patients with severe pneumonia were selected in the First Hospital of Danjiangkou from January 2017 to April 2018,and they were divided into control group(n=34)and observation group(n=39)according to therapeutic methods. Patients in control group received conventional treatment,while patients in observation group received fiberoptic bronchoscopic alveolar lavage based on conventional treatment. Clinical effect,subsidence/disappearance time of clinical symptoms and signs,control time of infection,hospital stays,index of pulmonary ventilation function and serum inflammatory cytokines levels before treatment,4 and 7 days after treatment were compared between the two groups. Results Clinical effect in observation group was statistically significantly better than that in control group(P<0.05). Disappearance time of fever,cough and expectoration,moist rale,control time of infection and hospital stays in observation group were statistically significantly shorter than those in control group(P<0.05). No statistically significant differences of OI,Cdyn or WOB was found between the two groups before treatment(P>0.05);4 and 7 days after treatment,OI and Cdyn in observation group were statistically significantly higher than those in control group,while WOB in observation group was statistically significantly lower than that in control group,respectively(P<0.05). No statistically significant differences of serum level of TNF-α,IL-6 or IL-8 was found between the two groups before treatment(P>0.05),while serum levels of TNF-α,IL-6 and IL-8 in observation group were statistically significantly lower than those in control group 4 and 7 days after treatment(P<0.05). Conclusion Fiberoptic bronchoscopic alveolar lavage has certain clinical effect in treating severe pneumonia,can effectively shorten the improvement time of clinical symptoms and signs, control time of infection,improve the pulmonary ventilation function and reduce the serum inflammatory cytokines levels,is helpful to relieve the inflammatory reaction.
引文
[1]李永涛,代富力.氨溴索注射液经纤维支气管镜肺泡灌洗治疗大叶性肺炎的临床疗效[J].罕少疾病杂志,2017,24(6):9-10,31.DOI:10.3969/j.issn.1009-3257.2017.06.004.
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[4]蒋建红,王勇,刘文明,等.降钙素原及C反应蛋白水平对重症肺炎预后的评估[J].内科急危重症杂志,2015,21(6):443-444.DOI:10.11768/nkjwzzzz20150616.
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[6]陈方榕.血清PCT、CRP、D-二聚体(FIB)联合检测对重症肺炎的早期诊断及预后评估的临床意义[J].黑龙江医药,2017,30(5):1080-1082.DOI:10.14035/j.cnki.hljyy.2017.05.066.
[7]黄沛全,杨德茂,黄泽鸿.纤维支气管镜肺泡灌洗治疗对急诊重症肺炎合并呼吸衰竭患者血清学指标的影响[J].海南医学院学报,2015,21(7):998-1001.DOI:10.13210/j.cnki.jhmu.20150226.001.
[8]WANG K,GAO M,YANG M Y,et al.Transcriptome analysis of bronchoalveolar lavage fluid from children with severe Mycoplasma pneumoniaepneumoniarevealsnovelgeneexpressionand immunodeficiency[J].Hum Genomics,2017,11(1):4-9.DOI:10.1186/s40246-017-0101-y.
[9]叶先钦,许伟珍,莫建伟,等.纤维支气管镜肺泡灌洗术对重症肺炎患者炎性因子及肺功能的影响[J].中国当代医药,2018,25(2):35-37.
[10]MISHRA R,CANO E,VENKATRAM S,et al.An interesting case of mycoplasma pneumonia associated multisystem involvement and diffuse alveolar hemorrhage[J].Respir Med Case Rep,2017,21:78-81.DOI:10.1016/j.rmcr.2017.03.022.
[11]孙砚诚.经纤维支气管镜支气管肺泡灌洗并注药治疗难治性肺炎的疗效和安全性[J].中国医药科学,2013,3(16):44-45.
[12]FILLATRE P,CHEVRIER S,REVEST M,et al.Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia[J].Eur J Clin Microbiol Infect Dis,2013,32(2):189-194.DOI:10.1007/s10096-012-1730-7.
[13]董朝晖,谢艳萍,陈志冬,等.纤维支气管镜联合肺泡灌洗术治疗重症肺部感染患者的临床疗效[J].中华医院感染学杂志,2018,28(3):364-366,397.DOI:10.11816/cn.ni.2018-171450.
[14]NAITO K,YAMASAKI K,YATERA K,et al.Bacteriological incidence in pneumonia patients with pulmonary emphysema:a bacterial floral analysis using the 16S ribosomal RNA gene in bronchoalveolar lavage fluid[J].Int J Chron Obstruct Pulmon Dis,2017,12(15):2111-2120.DOI:10.2147/COPD.S140901.
[15]BOUROS E,FILIDOU E,ARVANITIDIS K,et al.Lung fibrosisassociated soluble mediators and bronchoalveolar lavage from idiopathic pulmonary fibrosis patients promote the expression of fibrogenic factors in subepithelial lung myofibroblasts[J].ulmPharmacolTher,2017,46:78-87.DOI:10.1016/j.pupt.2017.08.012.
[16]DU X,MENG Q,SHARIF A,et al.Surfactant Proteins SP-A and SP-D Ameliorate Pneumonia Severity and Intestinal Injury in a Murine Model of Staphylococcus Aureus Pneumonia[J].Shock,2016,46(2):164-172.DOI:10.1097/SHK.0000000000000587.
[2]SIRCARM,RANJANP,GUPTAR,etal.Impactof bronchoalveolar lavage multiplex polymerase chain reaction on microbiological yield and therapeutic decisions in severe pneumonia in intensive care unit[J].J Crit Care,2016,31(1):227-232.DOI:10.1016/j.jcrc.2015.10.012.
[3]WANQJ,HUHF,HEYC,etal.Severepneumoniain mycophenolate mofetil combined with low-dose corticosteroidstreated patients with immunoglobulin A nephropathy[J].Kaohsiung J Med Sci,2015,31(1):42-46.DOI:10.1016/j.kjms.2014.10.004.
[4]蒋建红,王勇,刘文明,等.降钙素原及C反应蛋白水平对重症肺炎预后的评估[J].内科急危重症杂志,2015,21(6):443-444.DOI:10.11768/nkjwzzzz20150616.
[5]CHOI S H,HUH J W,HONG S B,et al.Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults:comparison with severe influenza virus-associated pneumonia[J].J Clin Virol,2015,11(10):41-47.DOI:10.1016/j.jcv.2014.11.010.
[6]陈方榕.血清PCT、CRP、D-二聚体(FIB)联合检测对重症肺炎的早期诊断及预后评估的临床意义[J].黑龙江医药,2017,30(5):1080-1082.DOI:10.14035/j.cnki.hljyy.2017.05.066.
[7]黄沛全,杨德茂,黄泽鸿.纤维支气管镜肺泡灌洗治疗对急诊重症肺炎合并呼吸衰竭患者血清学指标的影响[J].海南医学院学报,2015,21(7):998-1001.DOI:10.13210/j.cnki.jhmu.20150226.001.
[8]WANG K,GAO M,YANG M Y,et al.Transcriptome analysis of bronchoalveolar lavage fluid from children with severe Mycoplasma pneumoniaepneumoniarevealsnovelgeneexpressionand immunodeficiency[J].Hum Genomics,2017,11(1):4-9.DOI:10.1186/s40246-017-0101-y.
[9]叶先钦,许伟珍,莫建伟,等.纤维支气管镜肺泡灌洗术对重症肺炎患者炎性因子及肺功能的影响[J].中国当代医药,2018,25(2):35-37.
[10]MISHRA R,CANO E,VENKATRAM S,et al.An interesting case of mycoplasma pneumonia associated multisystem involvement and diffuse alveolar hemorrhage[J].Respir Med Case Rep,2017,21:78-81.DOI:10.1016/j.rmcr.2017.03.022.
[11]孙砚诚.经纤维支气管镜支气管肺泡灌洗并注药治疗难治性肺炎的疗效和安全性[J].中国医药科学,2013,3(16):44-45.
[12]FILLATRE P,CHEVRIER S,REVEST M,et al.Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia[J].Eur J Clin Microbiol Infect Dis,2013,32(2):189-194.DOI:10.1007/s10096-012-1730-7.
[13]董朝晖,谢艳萍,陈志冬,等.纤维支气管镜联合肺泡灌洗术治疗重症肺部感染患者的临床疗效[J].中华医院感染学杂志,2018,28(3):364-366,397.DOI:10.11816/cn.ni.2018-171450.
[14]NAITO K,YAMASAKI K,YATERA K,et al.Bacteriological incidence in pneumonia patients with pulmonary emphysema:a bacterial floral analysis using the 16S ribosomal RNA gene in bronchoalveolar lavage fluid[J].Int J Chron Obstruct Pulmon Dis,2017,12(15):2111-2120.DOI:10.2147/COPD.S140901.
[15]BOUROS E,FILIDOU E,ARVANITIDIS K,et al.Lung fibrosisassociated soluble mediators and bronchoalveolar lavage from idiopathic pulmonary fibrosis patients promote the expression of fibrogenic factors in subepithelial lung myofibroblasts[J].ulmPharmacolTher,2017,46:78-87.DOI:10.1016/j.pupt.2017.08.012.
[16]DU X,MENG Q,SHARIF A,et al.Surfactant Proteins SP-A and SP-D Ameliorate Pneumonia Severity and Intestinal Injury in a Murine Model of Staphylococcus Aureus Pneumonia[J].Shock,2016,46(2):164-172.DOI:10.1097/SHK.0000000000000587.