床旁纤维支气管镜辅助治疗卒中相关性肺炎的疗效

doi:10.3877/cma.j.issn.1674-1358.2016.03.015

目的

探讨床旁纤维支气管镜吸痰及肺泡灌洗在卒中相关性肺炎患者诊疗过程中的疗效。

方法

随机将60例卒中相关性肺炎患者分为对照组和试验组，每组患者各30例，其中对照组采用常规吸痰及抗感染等治疗；试验组采用纤维支气管镜吸痰及肺泡灌洗。对患者进行连续肺部感染评分。比较两组患者治疗后血气结果、血清炎症因子水平以及肺部感染评分情况。

结果

试验组患者冶疗后血气分析结果（pH：7.41 ± 0.04和7.15 ± 0.11，t = 2.280、P = 0.035；PaCO₂：6.70 ± 1.41 kPa和11.42 ± 1.86 kPa，t = 6.290、P = 0.000；PaO₂：10.33 ± 1.42 kPa和5.77 ± 2.01 kPa，t = 5.320、P = 0.000）、血清炎症因子（CRP：95.86 ± 42.35 mg/L和131.47 ± 33.53 mg/L；PCT：3.27 ± 1.12 ng/ml和7.57 ± 1.46 ng/ml；IL-6：63.52 ± 13.68 ng/L和94.47 ± 21.34 ng/L；TNF-α：35.41 ± 8.42 ng/L和54.62 ± 11.57 ng/L；P均< 0.01)、临床肺部感染评分（第3天：4.0 ± 1.1分和4.5 ± 1.3分，t = 2.180、P = 0.045；第7天：2.8 ± 1.0分和3.4 ± 1.2分，t = 2.690、P = 0.009）等指标均显著优于对照组患者。

结论

床边纤维支气管镜吸痰及肺泡灌洗安全、有效，具有很高的应用价值，特别适用于卒中相关性肺炎的患者。

关键词: 床旁纤维支气管镜, 肺泡灌洗, 卒中相关性肺炎

Objective

To investigate the effect of bedside fibrous bronchscope suction and alveolar lavage in patients with stroke associated pneumonia (SAP).

Methods

Total of 60 patients with stroke associated pneumonia were randomly divided into control group and experimental group, each group with 30 cases. The patients in control group were given treatement of sputum sucking and antibiotic drugs. Sputum sucking was replaced with bedside fibrous bronchscope suction and alveolar lavage in experimental group. The blood gas, serum levels of inflammatory factors and clinical pulmonary infection score of two groups were compared, respectively.

Results

The results of blood gas (pH: 7.41 ± 0.04 and 7.15 ± 0.11, t = 2.280, P = 0.035; PaCO₂: 6.70 ± 1.41 kPa and 11.42 ± 1.86 kPa, t = 6.290, P = 0.000; PaO₂: 10.33 ± 1.42 kPa and 5.77 ± 2.01 kPa, t = 5.320, P = 0.000), serum inflammatory factors (CRP: 95.86 ± 42.35 mg/L and 131.47 ± 33.53 mg/L; PCT: 3.27 ± 1.12 ng/ml and 7.57 ± 1.46 ng/ml; IL-6: 63.52 ± 13.68 ng/L and 94.47 ± 21.34 ng/L; TNF-α: 35.41 ± 8.42 ng/L and 54.62 ± 11.57 ng/L, P all < 0.01) and clinical pulmonary infection score (the third day: 4.0 ± 1.1 and 4.5 ± 1.3, t = 2.180, P = 0.045; the senventh day: 2.8 ± 1.0 and 3.4 ± 1.2, t = 2.690, P = 0.009) in experimental group were significantly superior to those in control group.

Conclusions

Bedside fibrous bronchoscope suction combined with alveolar lavage is a safe and effective method for treatment of SAP. It has high clinical value, and is worth application in clinic.

Key words: Beside fibrous bronchscope, Alveolar lavage, Stroke associated pneumonia.

表1 两组患者的血气参数（±s）

组别	心率（次/min）	pH值	PaCO₂（kPa）	PaO₂（kPa）
对照组	102.3 ± 12.5	7.15 ± 0.11	11.42 ± 1.86	5.77 ± 2.01
试验组	90.3 ± 10.6	7.41 ± 0.04	6.70 ± 1.41	10.33 ± 1.42
t值	10.350	2.280	6.290	5.320
P值	0.000	0.035	0.000	0.000

表1 两组患者的血气参数（±s）

组别	心率（次/min）	pH值	PaCO₂（kPa）	PaO₂（kPa）
对照组	102.3 ± 12.5	7.15 ± 0.11	11.42 ± 1.86	5.77 ± 2.01
试验组	90.3 ± 10.6	7.41 ± 0.04	6.70 ± 1.41	10.33 ± 1.42
t值	10.350	2.280	6.290	5.320
P值	0.000	0.035	0.000	0.000

表2 两组患者的炎症因子水平（±s）

组别	CRP（mg/L）	PCT（ng/ml）	IL-6（ng/L）	TNF-α（ng/L）
对照组	131.47 ± 33.53	7.57 ± 1.46	94.47 ± 21.34	54.62 ± 11.57
试验组	95.86 ± 42.35	3.27 ± 1.12	63.52 ± 13.68	35.41 ± 8.42
t值	38.660	3.210	21.670	21.460
P值	0.000	0.001	0.000	0.000

表2 两组患者的炎症因子水平（±s）

组别	CRP（mg/L）	PCT（ng/ml）	IL-6（ng/L）	TNF-α（ng/L）
对照组	131.47 ± 33.53	7.57 ± 1.46	94.47 ± 21.34	54.62 ± 11.57
试验组	95.86 ± 42.35	3.27 ± 1.12	63.52 ± 13.68	35.41 ± 8.42
t值	38.660	3.210	21.670	21.460
P值	0.000	0.001	0.000	0.000

表3 两组患者治疗后的CPIS分值（±s）

组别	第1天	第3天	第7天	第14天
对照组	4.8 ± 1.6	4.5 ± 1.3	3.4 ± 1.2	1.9 ± 1.0
试验组	4.6 ± 1.2	4.0 ± 1.1	2.8 ± 1.0	1.7 ± 1.1
t值	0.650	2.180	2.690	0.520
P值	0.524	0.045	0.009	0.508

表3 两组患者治疗后的CPIS分值（±s）

组别	第1天	第3天	第7天	第14天
对照组	4.8 ± 1.6	4.5 ± 1.3	3.4 ± 1.2	1.9 ± 1.0
试验组	4.6 ± 1.2	4.0 ± 1.1	2.8 ± 1.0	1.7 ± 1.1
t值	0.650	2.180	2.690	0.520
P值	0.524	0.045	0.009	0.508

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The effect of bedside fibrous bronchscope auxiliary treatment for stroke associated pneumonia

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The effect of bedside fibrous bronchscope auxiliary treatment for stroke associated pneumonia