纤维支气管镜下肺泡灌洗辅助治疗呼吸机相关性肺炎的效果

陈慧丽 朱锋 汪漩

摘要：目的  探讨纤维支气管镜下肺泡灌洗辅助治疗呼吸机相关性肺炎的临床疗效。方法  选取2017年4月～2019年8月我院收治的呼吸机相关性肺炎患者102例作为研究对象，采用随机数字表法分为对照组和观察组，每组51例。对照组行常规治疗，观察组在对照组基础上行纤维支气管镜下肺泡灌洗辅助治疗，比较两组治疗效果、炎性因子水平[C-反应蛋白（CRP）、白介素-8（IL-8）]。结果  观察组治疗总有效率为96.08%，高于对照组的82.35%，差异有统计学意义（P<0.05）;治疗后，两组CRP、IL-8水平均较治疗前降低，且观察组低于对照组，差异有统计学意义（P<0.05）。结论  经纤维支气管镜下肺泡灌洗辅助治疗呼吸机相关性肺炎临床效果确切，可有效降低患者炎性因子水平，改善炎性反应，促进患者病情恢复。

关键词：纤维支气管镜;肺泡灌洗;呼吸机相关性肺炎

中图分类号：R563.1                                  文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2020.11.032

文章编号：1006-1959（2020）11-0107-02

Abstract：Objective  To explore the clinical efficacy of fiberoptic bronchoscopic alveolar lavage in the adjuvant treatment of ventilator-associated pneumonia.Methods  A total of 102 patients with ventilator-associated pneumonia admitted in our hospital from April 2017 to August 2019 were selected as the research object， using the random number table method to divided into control group and observation group， with 51 cases in each group. The control group received routine treatment， and the observation group underwent adjuvant alveolar lavage under the control of the bronchofibroscope， compare the treatment effect and inflammatory factor level [C-reactive protein （CRP）， interleukin-8 （IL-8）] changes between the two groups.Results  The total effective rate of treatment in the observation group was 96.08%， higher than 82.35% that in the control group， the difference was statistically significant（P<0.05）; After treatment， the levels of CRP and IL-8 in the two groups were lower than before treatment， and the observation group was lower than the control group， the difference was statistically significant（P<0.05）.Conclusion  The alveolar lavage under fiberoptic bronchoscopy has a definite clinical effect on the treatment of ventilator-associated pneumonia. It can effectively reduce the level of inflammatory factors， improve the inflammatory response， and promote the recovery of the patient's condition.

Key words：Fiberoptic bronchoscopy;Alveolar lavage;Ventilator-associated pneumonia

呼吸機相关肺炎（ventilator-associated pneumonia）是机械通气过程中常见且较为严重的并发症之一，患者一旦发生，则易造成脱机困难，严重者甚至危及生命。由于呼吸机相关肺炎的致病菌、发病因素差异较大，其临床诊断与治疗不同于一般肺炎，病死率较高。据报道[1]，呼吸机相关肺炎的病死率为20%～71%。临床治疗呼吸机相关性肺炎多采用抗生素，但效果有限，难以达到预期，加之抗生素滥用易产生多重耐药菌，可能导致多重耐药菌感染，严重影响患者生活质量，因此积极探寻更加完善的治疗方法具有重要的临床意义[2]。本研究结合2017年4月～2019年8月我院收治的102例呼吸机相关性肺炎患者的临床资料，观察纤维支气管镜下肺泡灌洗辅助治疗呼吸机相关性肺炎的临床效果，现报道如下。