经纤维支气管镜肺泡灌洗治疗重症肺炎的临床研究(1)
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【摘要】目的:观察经纤维支气管镜肺泡灌洗治疗急性重症肺炎的临床价值。 方法:31例重症肺炎患者在常规治疗基础上行支气管肺泡灌洗,并与同期26例常规治疗患者作比较,观察两组病例的治疗疗效,记录并分别比较两组在灌洗前及灌洗后48h的急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分、急性肺损伤评分和肺感染评分。 结果:灌洗组患者在灌洗48h后与非灌洗组相比,各项评分均有显著下降,明显低于非灌洗组(P<0.05);灌洗组总有效率为93.5%,与非灌洗组总有效率76.9%相较有显著性差异(P<0.05)。 结论:经纤维支气管镜肺泡灌洗治疗急性重症肺炎,疗效确切,可缩短病程,提高治愈率。
【关键词】支气管肺泡灌洗纤维支气管镜重症肺炎
Clinical study of bronchoalveolar larage in treatment of severe pneumonia
He Jun,Hu Song
Intencive care unit of the first hospitol of Changsha city, Hunan province, China
【Abstract】 ObjectiveTo explore the clinical value of bronchoalveolar larage (BAL) in the treatment of severe pneumonia. Methods57 patients were randomly divided into BAL group and non-BAL group, 31 patients in the BAL group received BAL in addition of roution treatment and 26 patients had only roution treatment in the non-BAL group. The effect of the 2 groups was observed and APACHE Ⅱ score, Acute Lung injury score, Pulmonary infection score were compared Comparisons between the 2 groups. Resultscompared to the non-BAL group, efficient in the BAL group was 93.5% but 76.9% in the non-BAL group. APACHE Ⅱ score, Acute Lung injury score, Pulmonary infection score in the BAL group were significantly lower than in the non-BAL group. Conclusionbronchoalveolar larage was effective in the treatment of severe pneumonia, and shortening the course and improving the cure rate.
【Key words】Bronchoalveolar lavegeSevere pneumoniaFiberoptic bronchoscopy
重症肺炎是重症医学科中常见的危急重症,具有进展快、治疗难度大等特点,常并发呼吸衰竭,住院时间长,病死率高,常规抗炎、祛痰、支持等综合治疗效果不佳。我们在常规综合治疗的基础上应用纤维支气管镜肺泡灌洗术,加强痰液引流,减少炎性代谢产物及毒素的吸收,明显地提高了疗效,缩短了病程,取得了良好的临床效益及卫生经济学效益。现报告如下:
1 资料与方法
1.1一般资料
我科2008-2010年共收治重症肺炎患者57例,男性33例,女性24例,平均年龄50.1(34~87)岁。气管插管39例,气管切开18例,均行机械通气。其中慢性阻塞性肺疾病急性加重28例,社区获得性肺炎15例,吸入性肺炎5例,急性脑血管意外5例,重症肌无力1例,脑外科术后3例。金葡菌肺炎10例,肺炎克雷伯杆菌9例,绿脓杆菌肺炎7例,鲍曼不动杆菌11例,霉菌感染1例,混合菌感染19例。双侧肺野炎性病变有27例,单侧肺多叶病变有24例,单肺叶病变6例。随机分为灌洗组(n=31)与非灌洗组(n=26),两组性别、年龄、病程、严重程度分级差别无统计学差异(P>0.05),均符合重症肺炎的诊断标准[1],并且排除合并有严重心血管疾病及出凝血功能异障碍或明显血流动力学改变的患者。
1.2方法
两组患者在入院后均给予机械通气、抗感染、祛痰,维持水电解质平衡及营养支持等治疗。灌洗组患者用Olympus纤维支气管镜FBIT20型检查及治疗,经气管插管或气管套囊插入纤维支气管镜,在呼吸机机械通气情况下进行纤维支气管镜灌洗。逐级观察气管、主支气管以及叶、段、亚段支气管情况,重点参照胸部X线及CT检查结果,对肺部感染和肺不张的相应部位进行详细检查,尽量吸净呼吸道分泌物,留取分泌物送培养及药敏,用37℃左右生理盐水10ml-20ml /次反复灌洗,总量不超过200ml,负压(<200mmHg)吸引 ......
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