支气管镜灌洗术在老年重症肺部感染治疗中的临床价值

Clinical value of bronchoscopic lavage in treatment of severe pulmonary infection in the elderly

【摘要】目的 探讨支气管镜灌洗术在治疗老年重症肺部感染中的应用价值。方法 入选陕西省人民医院呼吸内科住院部及重症医学科2013年5月至2016年5月收治的118例老年重症肺部感染患者,根据患者选择的治疗方式分为观察组与对照组,各59例。对照组采用常规经验性治疗,观察组在常规治疗基础上应用支气管镜灌洗术,比较两组患者基本资料及治疗后的临床疗效(血气指标、体温正常时间及住院时间)。采用 SPSS 19.0软件对数据进行统计分析,根据数据类型,组间比较采用t检验或χ²检验。结果 两组治疗前基线资料比较,差异无统计学意义(P>0.05)。观察组治疗后各血气指标与治疗前比较,氧分压(PaO₂)、血氧饱和度(SaO₂)、氧合指数(氧分压/吸入氧浓度,PaO₂/FiO₂)均较高,二氧化碳分压(PaCO₂)、C-反应蛋白(CRP)、白细胞(WBC)均较低,差异有统计学意义；与对照组比较,PaO₂[(86.30±4.27) vs (74.56±3.84)mmHg]、SaO₂[(94.06±1.38)% vs(88.56±1.25)%]和PaO₂/FiO₂[(253.42±26.32) vs(227.34±20.01)]显著高于对照组,PaCO₂[(45.57±1.46) vs(53.46±0.53)mmHg]、CRP[(8.58±0.74) vs (12.52±0.96)mg/L]、WBC[(7.64±2.15)×10⁹ vs (10.38±2.58)×10⁹/L]显著低于对照组,差异有统计学意义(P＜0.01)。治疗后观察组体温恢复至正常所需时间[(8.34±3.42) vs (11.52±5.03)d]及住院时间[(15.32±3.28) vs (19.21±6.54) d]显著低于对照组,差异均有统计学意义(P＜0.01)。治疗后观察组总有效率为89.83％,显著高于对照组72.88％,差异有统计学意义(P＜0.05)。手术中患者总体耐受性良好,无严重并发症发生。结论 联合采用支气管镜肺泡灌洗术治疗老年重症肺部感染疗效显著,具有较高的临床应用价值。

基金项目:陕西省科技惠民专项(2013K14-02-09)

【Abstract】Objective To investigate the value of bronchoscopic lavage in the treatment of severe pulmonary infection in the elderly.Methods A total of 118 elderly patients with severe pulmonary infection admitted in the Department of Respiratory Diseases and Intensive Care Unit of our hospital from May 2015 to May 2016 were recruited in this study. They were divided into observation group and control group according to the treatment they received, with 59 patients in each group. The patients in the control group were treated with routine therapy. The observation group was treated with bronchoscopic lavage besides the routine treatment. The baseline data and clinical efficacy (blood gas indices, time to normal body temperature and length of hospital stay) were compared between the 2 groups. SPSS statistics 19.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed for different data types. Results There were no significant differences in baseline data between two groups before treatment (P>0.05). The blood gas indices changed significantly after the treatment in observation group compared with before treatment (PaO₂, SaO₂ and PaO₂/FiO₂ increased, while PaCO₂, CRP and WBC decreased). The levels of PaO₂[(86.30±4.27) vs (74.56±3.84) mmHg], SaO₂ [(94.06±1.38)% vs (88.56±1.25)%] and PaO₂/FiO₂ [(253.42±26.32) vs (227.34±20.01)] were significantly higher, while PaCO₂ [(45.57±1.46) vs (53.46±0.53) mmHg], CRP [(8.58±0.74) vs (12.52±0.96) mg/L], and WBC [(7.64±2.15)×10⁹ vs (10.38±2.58)×10⁹/L] were significantly lower in observation group than those in control group (all P<0.01). The observation group also had obviously shorter time to normal body temperature [(8.34±3.42) vs (11.52±5.03) d]and length of hospital stay [(15.32±3.28) vs (19.21±6.54) d] compared with the control group (P<0.05). The total effective ratewas 89.83% in the observation group, significantly higher than that in the control group (72.88%, P<0.05). All patients showed good tolerance to the surgery, and no serious complications occurred. Conclusion Bronchoalveolar lavage is effective in the treatment of severe pulmonary infection in the elderly, and has great clinical value.