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目的探讨便携式纤支镜肺泡灌洗在重症肺炎有创机械通气患者中的应用效果。方法选取2013年6月—2014年12月四川医科大学附属第一医院收治的重症肺炎患者76例,均行有创机械通气治疗,并按入院顺序分为观察组和对照组,各38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便携式纤支镜肺泡灌洗治疗,比较两组患者治疗前后降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、中性粒细胞分数(N)、动脉血氧分压(Pa O2)及动脉血二氧化碳分压(Pa CO2);同时记录两组患者有创通气时间、住院时间、死亡及并发症发生情况。结果治疗前两组患者PCT、hs-CRP、WBC、N、Pa O2及Pa CO2比较,差异无统计学意义(P>0.05);治疗后观察组患者PCT、hs-CRP、WBC、N及Pa CO2低于对照组,Pa O2高于对照组(P<0.05)。观察组患者有创通气时间和住院时间均短于对照组,并发症发生率和病死率均低于对照组(P<0.05)。结论便携式纤支镜肺泡灌洗可有效改善重症肺炎有创机械通气患者血液学指标,缩短其有创通气时间和住院时间,降低其病死率及并发症发生率,临床应用效果较好。
Objective To investigate the effect of portable bronchoscopy lavage in severe pneumonia patients with invasive mechanical ventilation. Methods Seventy-six patients with severe pneumonia admitted from the First Affiliated Hospital of Sichuan Medical University from June 2013 to December 2014 were enrolled in this study. All patients were divided into observation group and control group with 38 cases in each group. The patients in the control group were given conventional therapy. The patients in the observation group were given bronchofibroscopy and bronchoalveolar lavage on the basis of routine treatment. The levels of PCT, hs-CRP, White blood cell count (WBC), neutrophil fraction (N), arterial oxygen pressure (Pa O2) and arterial carbon dioxide partial pressure (Pa CO2) .At the same time, the duration of invasive ventilation, hospital stay, Complications of the situation. Results There was no significant difference in PCT, hs-CRP, WBC, N, Pa O2 and Pa CO2 between the two groups before treatment (P> 0.05). After treatment, the levels of PCT, hs-CRP, CO2 was lower than the control group, Pa O2 was higher than the control group (P <0.05). Patients in the observation group had shorter duration of invasive ventilation and hospital stay than those in the control group, with complication rates and mortality rates being lower than those in the control group (P <0.05). Conclusions Portable bronchoscopy bronchoalveolar lavage can effectively improve the hematological indexes of patients with severe pneumonia with invasive mechanical ventilation, shorten the duration of invasive ventilation and hospital stay, reduce the mortality and complications, and have a good clinical effect.