经纤维支气管镜肺泡灌洗治疗难治性肺部感染(1)
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2010年6月25日
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[摘要] 目的:探讨经纤维支气管镜支气管肺泡灌洗对难治性肺部感染的临床疗效。方法:将57例难治性肺部感染患者随机分为灌洗组30例和对照组27例,对照组采用抗感染等常规治疗,灌洗组在常规治疗的基础上加用支气管肺泡灌洗,治疗2周后对两组治疗效果进行临床观察和统计学分析。结果:灌洗组痰菌培养阳性率为76.67%,致病菌清除率为86.61%,治疗总有效率为90.00%; 对照组痰菌培养阳性率为40.74%,致病菌清除率为45.45%,治疗总有效率为66.67%,两组间比较差异有统计学意义(P<0.05)。结论:支气管肺泡灌洗治疗难治性肺部感染安全有效。
[关键词] 纤支镜;支气管肺泡灌洗;难治性肺部感染;治疗
[中图分类号] R563 [文献标识码]A [文章编号]1674-4721(2010)06(c)-032-02
Bronchoalveolar lavage by bronchofibroscope in patients with refractory pulmonary infection
LI Zhiying, SONG Bing, CHEN Jiming, DU Xiufang,CHEN Yanwei,HUANG Ping,CHEN Shengwen
(Department of Respiratory, Nanshan People’s Hospital Affiliated to Guangdong Medical College, Guangdong Province,Shenzhen518052, China)
[Abstract] Objective: To evaluate the clinical efficacy of bronchoalveolar lavage(BAL)treatment in patients with refractory pulmonary infection. Methods: 57 patients with refractory pulmonary infection were randomly assigned to a BAL treatment group or a routine treatment group for 2 weeks. The clinical efficacy of the two groups were analyzed. Results: At week 2, the positive rate of sputum culture in BAL group was higher than control group(76.67% vs 40.74%, P<0.01). The conversion rate of pathogenic bacteria in BAL group was also higher than the control group(86.61% vs 45.45%, P<0.05). There were significant differences in the effective rate in between the two groups (90.00% vs 66.67%, P<0.05).Conclusion:BAL is rapid, safe and well-tolerated in treating patients with refractory pulmonary infection.
[Key words] Bronchofibroscope; Bronchoalveolar lavage(BAL); Refractory pulmonary infection;Treatment
难治性肺部感染是指病情严重或病程延长、经抗感染药物积极治疗仍无改善、迁延不愈甚至恶化的一类肺炎,目前已成为临床医学的一大难题[1]。本院对30例严重肺部感染所致难治性肺部炎症患者加用经纤维支气管镜支气管肺泡灌洗(bronchoalveolar lavage,BAL)治疗取得良好效果,现报道如下:
1资料与方法
1.1 一般资料
选择2009年2月～2010年2月在本院呼吸内科住院治疗的难治性肺部感染患者57例,其中,男33例,女24例,年龄20～65岁,平均(41.35±9.76)岁。其原发病为慢性阻塞性肺疾病急性发作19例,支气管扩张合并感染10例,肺脓肿7例,肺癌合并感染6例,呼吸机相关性肺炎6例,重症肺炎5例,肺不张4例。随机分为治疗组30例,对照组27例,两组患者在年龄、性别、病程以及基础病方面差异无统计学意义(P>0.05)。
1.2 入选标准
本组患者为常规抗菌药物治疗7 d症状体征无明显改善,X线胸片或肺部CT检查均提示肺部炎症仍无吸收或吸收不明显;或者在使用抗菌药物治疗后症状、体征虽有好转,但2周后复查胸部X线和CT,病变影吸收<50%的肺炎,并通过相关检查排除肺结核、肺水肿及非感染性肺间质性疾病等其他疾病 ......
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