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。

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．

目的 研究纤维支气管镜下给药治疗耐多药空洞型肺结核的临床治疗效果。方法 抽取我院2017年1月—2019年12月期间收治的空洞型肺结核耐多药(同时耐INH、RFP,其他药敏试验抗痨药物均敏感)患者74例作为研究对象,其中38例设作治疗组,在应用传统抗痨药物帕司烟肼、EMB、PZA、TH1321治疗基础上,应用纤维支气管镜下给药治疗,药物选择AMK和左氧氟沙星;36例设作对照组,单纯应用传统抗结核药物帕司烟肼、EMB、PZA、TH1321治疗,比较两组临床治疗效果。结果 治疗组临床治疗总有效率94.7%,高于对照组66.7%,两组比较差异有统计学意义(P＜0.05);治疗后,两组QOL评分均高于治疗前,治疗组评分高于对照组,比较差异有统计学意义(P＜0.05);治疗组患者痰菌转阴时间、病灶减少时间、空洞缩小时间等指标均优于对照组,比较差异有统计学意义(P＜0.05);两组不良反应比较无差异(P＞0.05)。结论 纤维支气管镜下给药应用AMK和左氧氟沙星,可以有效治疗耐多药空洞型肺结核,取得理想的临床治疗效果,能有效改善患者临床症状,缩短痰菌转阴、病灶减少和空洞缩小的时间,有效改善患者的生活质量,而且治疗安全性较高,可以应用于临床推广。

Objective To study the clinical effect of drug administration under fiberoptic bronchoscope in the treatment of multi drug resistant (mdr) cavitary pulmonary tuberculosis. Methods 74 patients with cavitary pulmonary tuberculosis(who were resistant to INH and RFP at the same time and sensitive to other drugs in other drug sensitivity tests) were selected as the study subjects. 38 of them were set up as the treatment group. On the basis of the treatment with traditional antituberculosis drugs such as pasiazide, EMB, PZA and TH1321, they were treated with fiberoptic bronchoscopy and drug selection AMK and levofloxacin, 36 cases as control group, were treated with traditional antituberculotic drugs, such as pasiazide, EMB, PZA and TH1321. Results The total effective rate of clinical treatment in the treatment group was 94.7%, higher than 66.7% in the control group, and the difference between the two groups was statistically significant(P<0.05);there was no difference in adverse reactions between the two groups(P>0.05). Conclusion Administration of AMK and levofloxacin under fiberbronchoscope may effectively treat mdr-cavitary tuberculosis, achieve ideal clinical treatment effect, effectively improve the clinical symptoms of patients, shorten the time of sputum bacteria turning negative, focus reduction and cavitary reduction, effectively improve the quality of life of patients. The treatment safety is high, which may be applied in clinical promotion.

目的 对比纤维支气管镜肺灌洗治疗和常规治疗重症肺部感染患者的临床疗效。方法 将2015年5月—2017年4月间在我院接受治疗的92例重症肺部感染患者作为研究对象,按照随机数字表分为实验组(n=46)和对照组(n=46),其中对照组采用常规对症治疗,实验组加以实施纤维支气管镜肺灌洗治,治疗后,纤支镜气道灌洗检测两组患者的血气分析指标变化,采用ELISA测定血清炎症因子含量,及放射免疫法测定血清应激激素含量。结果 经比较,实验组患者治疗后的PaO₂、SaO₂、PaCO₂高于对照组患者(P<0.05);实验组患者的血清炎症因子hs-CRP、IL-6、IL-8水平低于对照组患者(P<0.05);此外,实验组患者的Ang-II、NE、Cor含量低于对照组患者(P<0.05)。结论 纤支镜气道灌洗可有助于改善重症肺部感染患者的肺通气功能,降低全身炎症应激程度,促进疾病康复。

Objective To compare the clinical efficacy of bronchoalveolar lavage and conventional treatment in patients with severe pulmonary infection. Methods 92 patients with severe pulmonary infection treated in our hospital from May 2015 to April 2017 were selected as research objects. They were randomly divided into experimental group (n=46) and control group (n=46). The control group was treated with conventional symptomatic treatment, The experimental group implemented bronchoscopy lung lavage treatment. After treatment, blood gas bronchoscopic airway lavage in two groups were detected with analysis indexes. Serum inflammatory factors were determined by ELISA, and the serum levels of stress hormones were determined by radioimmunoassay. Results After the treatment, the PaO₂, SaO₂ and PaCO₂ in the experimental group were higher than those in the controlgroup(P<0.05). The levels of serum inflammatory factors hs-CRP, IL-6、IL-8 in the experimental group were lower than those in the control group (P<0.05); in addition, the levels of Ang-II, NE and Cor in the experimental group were lower than those in the control group(P<0.05). Conclusion Bronchoscopy airway lavage may help to improve the pulmonary ventilation function of patients with severe pulmonary infection, reduce the degree of systemic inflammatory stress, and promote disease recovery.