纤维支气管镜肺泡灌洗吸痰术联合药物治疗ICU重症肺部感染患者疗效以及炎症因子的影响

doi:10.20223/j.cnki.1000-8535.2024.10.008

摘要/Abstract

摘要： 目的探讨对于重症肺部感染患者采用药物+纤维支气管镜肺泡灌洗吸痰术治疗的效果。方法选取2021年9月—2023年5月在郑州市第一人民医院ICU中94例肺部感染患者,分为观察组、对照组,对照组进行常规治疗,观察组采用药物+纤维支气管镜肺泡灌洗吸痰术治疗,对比两组患者的疗效、症状的缓解时间、炎性因子、实验室相关指标以及不良反应。结果治疗后,观察组患者的治疗有效率91.49%高于对照组76.60%（χ²=3.887,P<0.05）,观察组患者的发热、肺部湿啰音、咳嗽以及咳痰等症状的缓解时间分别为（3.09±1.25）（4.17±2.24）（3.95±1.53）（4.05±1.77）d,均低于对照组（5.14±2.43）（7.03±3.23）（6.40±2.62）（6.32±1.81）d（t=5.143、4.988、5.536、6.147,P<0.05）,观察组的 C 反应性蛋白（C-reactive protein,CRP）、白细胞介素-6（Interleukin-6,IL-6）以及Toll样受体4（Toll-like receptor 4,TLR-4）水平分别为（3.64±0.87）mg/L、（54.59±10.65）ng/mL、（7.94±1.57）%,均低于对照组（7.51±1.43）mg/L、（87.66±11.17）ng/mL、（12.11±2.48）%（t=15.850、14.690、9.740,P<0.05）,观察组的气道压力、动脉血二氧化碳分压（partial pressure of carbon dioxide in artery,PaCO₂）水平分别为（6.92±3.60）cmH₂O、（43.19±6.29）mmHg,低于对照组（8.68±2.98）cmH₂O、（55.43±5.95）mmHg,观察组动脉氧分压（Partial arterial oxygen pressure,PaO₂）（86.06±5.31）mmHg、血氧饱和度（oxyhemoglobin saturation,SpO₂）（98.03±6.63）%高于对照组（68.04±5.19）mmHg、（90.22±5.51）%要高（t=2.582、9.692、16.638、6.221,P<0.05）,观察组中的不良反应发生率为2.13%与对照组10.64%比较差异无统计学意义（χ²=2.849,P>0.05）。结论对处于ICU中的肺部感染患者治疗时,使用药物+纤维支气管镜肺泡灌洗吸痰术能够改善患者症状,降低炎性因子水平。

关键词: 纤维支气管镜, 肺部感染, 肺泡灌洗吸痰术

Abstract: Objective To investigate the efficacy of medication combined with bronchoscopic alveolar lavage and sputum aspiration in ICU patients with severe pulmonary infection. Methods Ninety-four patients with pulmonary infection in the ICU of Zhengzhou First People's Hospital from September 2021 to May 2023 were selected and divided into observation group and control group．The control group received routine treatment,and the observation group was treated with medication and bronchoscopic alveolar lavage and sputum aspiration．The efficacy,duration of symptom remission,inflammatory factors,laboratory-related indicators and adverse reactions were compared between the two groups. Results After treatment,the effective rate of 91.49% in observation group was significantly higher than 76.60% in control group（χ²=3．887,P<0.05）．The relief time of fever,pulmonary rale,cough and sputum in observation group was（3.09±1.25）d,（4.17±2.24）d,（3.95±1.53）d,and（4.05±1.77）d,respectively,which were significantly lower than the control group[（5.14±2.43）d,（7.03±3.23）d,（6.40±2.62）d and（6.32±1.81）d]（t=5.143,4.988,5.536,6.147,P<0.05）．The levels of CRP,IL-6 and TLR-4 in the observation group were（3.64±0.87）mg/L,（54.59±10.65）ng/mL and（7.94±1.57）%,respectively．They were significantly lower than（7.51±1.43）mg/L,（87.66±11.17）ng/mL and（12.11±2.48）% in the control group（t=15.850,14.690,9.740,P<0.05）．The airway pressure and PaCO₂ levels of the observation group were（6.92±3.60）cmH₂O and（43.19±6.29）mmHg,respectively,which were significantly lower than those of the control group[（8.68±2.98）cmH₂O and（55.43±5.95）mmHg]．The levels of PaO₂[（86.06±5.31）mmHg] and SpO₂[（98.03±6.63）%] in the observation group were higher than those in the control group[（68.04±5.19）mmHg and（90.22±5.51）%],and there were statistically significant differences（t=2.582,9.692,16.638,6.221,P<0.05）．The adverse reactions of 2.13% in the observation group were lower than 10.64% in the control group,and there was no statistically significant difference（χ²=2.849,P>0.05）. Conclusions In ICU patients with severe lung infection,the treatment of drugs combined with alveolar lavage and fiberoptic bronchoscopic aspiration is better,and can significantly improve the symptoms and inflammatory factor levels of patients．

Key words: fibroptic bronchoscopy, lung infection, alveolar lavage sputum aspiration

张定成, 石正松, 王徳昌, 赵志强, 余勇. 纤维支气管镜肺泡灌洗吸痰术联合药物治疗ICU重症肺部感染患者疗效以及炎症因子的影响[J]. 广州医药, 2024, 55(10): 1146-1151.

ZHANG Dingcheng, SHI Zhengsong, WANG Dechang, ZHAO Zhiqiang, YU Yong. Effect of bronchofiberoptic alveolar lavage and sputum aspiration combined with medication on ICU patients with severe pulmonary infection and the influence of inflammatory factors[J]. Guangzhou Medical Journal, 2024, 55(10): 1146-1151.

参考文献

[1] CHEN X,SUN J,CHEN Y,et al.Pneumonia caused by Schizophyllum commune in a patient with diabetes:A case report and comprehensive literature review[J].Medicine(Baltimore),2023,102(22):e33773.
[2] OGAWA M,HOSHINA T,ABUSHAWISH A,et al.Evaluation of the usefulness of culture of induced sputum and the optimal timing for the collection of a good-quality sputum sample to identify causative pathogen of community-acquired pneumonia in young children:A prospective observational study[J].J Microbiol Immunol Infect,2023,56(5):1036-1044.
[3] MUZIEN S J,BAYU H T,SHUMBASH K Z,et al.Neurogenic pulmonary edema following Endoscopic third Ventriculostomy in patient with Hydrocephalous;case report[J].Int J Surg Case Rep,2023(106):108191.
[4] 陈建军. 纤维支气管镜吸痰灌洗治疗肺部感染患者的效果评估[J].中外医疗,2023,42(12):105-108.
[5] 肖海励,师继超.纤维支气管镜肺泡灌洗联合美罗培南治疗重症肺部感染的效果及对患者肺功能的影响[J].临床医学,2023,43(4):41-43.
[6] MALAS M,ALTHOBAITI AA,SINDI A,et al.Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques:A systematic review and network meta-analysis[J].J Otolaryngol Head Neck Surg,2023,52(1):21.
[7] 刘燕山,张海生,刘德智.纤维支气管镜灌洗联合血必净治疗重症肺炎并急性呼吸窘迫综合征临床疗效[J].深圳中西医结合杂志,2023,33(4):91-93.
[8] 周达坤,石代辉.纤维支气管镜吸痰灌洗在重症肺部感染患者中的治疗效果[J].安徽医专学报,2023,22(1):46-47,50.
[9] 吴琦,卢经伟,陈礼刚,等.纤维支气管镜吸痰灌洗治疗RICU肺部感染的效果[J].中外医学研究,2023,21(6):6-10.
[10] 陈志贵. 纤维支气管镜检查和肺泡灌洗术在重症肺部感染中应用意义[J].中国医疗器械信息,2022,28(23):123-125.
[11] 朱明达,丁志刚,李田峰,等.纤支镜引导下支气管冲洗吸痰术在急诊肺部感染患者中的应用1例[J].宁夏医科大学学报,2022,44(11):1187-1188.
[12] WANG L,ZHA P,WANG Y,et al.The value of macrogene second-generation sequencing in the diagnosis,guidance of drug use,and efficacy monitoring of infectious pneumonia in premature infants[J].Comput Math Methods Med,2022(2022):4398614.
[13] LI Y,LI X,WEN Z,et al.Effect of open versus closed endotracheal suctioning on intracranial pressure in severe brain-injured children:Study protocol for a randomized controlled trial[J].Nurs Open,2021,8(5):2886-2891.
[14] 欧志成. 纳洛酮联合纤维支气管镜治疗Ⅱ型呼吸衰竭患者的效果[J].中国民康医学,2022,34(14):34-36,40.
[15] 柳红艳. 纤维支气管镜吸痰治疗重症肺部感染临床观察[J].中国医疗器械信息,2022,28(13):100-102,161.
[16] 秦毅,巩亚婷,王卓.电子支气管镜联合阿米卡星肺泡灌洗对重症肺部感染患者炎症反应及肺上皮细胞功能的影响[J].临床和实验医学杂志,2022,21(13):1376-1380.
[17] 王静,李楠楠,黄大海.丙泊酚联合右美托咪定在肺炎患者支气管-肺泡灌洗术中的临床应用[J].中华肺部疾病杂志(电子版),2022,15(3):406-409.
[18] KIKUTANI K,OHSHIMO S,SADAMORI T,et al.Quantification of respiratory sounds by a continuous monitoring system can be used to predict complications after extubation:A pilot study[J].J Clin Monit Comput,2023,37(1):237-248.
[19] 段冲亚. 美罗培南辅助纤维支气管镜肺泡灌洗联合中医治疗重症肺部感染的效果分析[J].黑龙江中医药,2022,51(3):91-93.
[20] MARQUES R,ARAÚJO F,FERNANDES M,et al.Validation testing of the European Portuguese critical-care pain observation tool[J].Healthcare(Basel),2022,10(6):1075.
[21] NONOYAMA T,SHIGEMI H,YASUTAKE C,et al.Effective mechanical insufflation-exsufflation in a patient with difficulty in sputum discharge and intensive care unit-acquired weakness:A case report[J].Cureus,2022,14(2):e21847.
[22] HARUNA J,TATSUMI H,KAZUMA S,et al.Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial:A single-center retrospective cohort study[J].JA Clin Rep,2022,8(1):5.
[23] WU C,ZHANG Y,YANG L,et al.Effect of capsaicin atomization-induced cough on sputum excretion in tracheotomized patients after hemorrhagic stroke:A randomized controlled trial[J].J Speech Lang Hear Res,2021,64(11):4085-4095.
[24] SAWANO T,SENOO Y,YOSHIDA I,et al.Emergency hospital evacuation from a hospital within 5 km radius of fukushima daiichi nuclear power plant:A retrospective analysis of disaster preparedness for hospitalized patients[J].Disaster Med Public Health Prep,2022,16(5):2190-2193.
[25] MARTÍNEZ-ALEJOS R,MARTÍ J D,LI BASSI G,et al.Effects of mechanical insufflation-exsufflation on sputum volume in mechanically ventilated critically ill subjects[J].Respir Care,2021,66(9):1371-1379.
[26] 周菲菲,王国胜,董海丽.氨溴索静脉用药联合不同通气方式治疗新生儿呼吸窘迫综合征的疗效评价[J].广州医药,2023,54(1):76-79.
[27] 黄娟,温雅,张华根,等.支气管镜下肺泡灌洗阿米卡星治疗老年支气管扩张合并感染患者的疗效[J].广州医药,2022,53(6):31-35.