支气管肺泡灌洗对重症肺炎合并呼吸衰竭患者正五聚体蛋白－3水平的影响

Effect of bronchoalveolar lavage with fiberoptic bronchoscopy on pentraxin-3 level in severe pneumonia patients complicated with respiratory failure

摘要:

目的 探讨纤维支气管镜引导下支气管肺泡灌洗对重症肺炎伴呼吸衰竭患者血气指标及正五聚体蛋白－3(PTX3)水平的影响。方法 回顾性分析泰州市人民医院重症医学科2016年2月至2018年1月收治的重症肺炎伴呼吸衰竭患者60例,根据是否纤维支气管镜引导下行支气管肺泡灌洗分为对照组31例和研究组(支气管肺泡灌洗)29例。2组患者均给予辅助通气、抗感染、化痰、维持内环境稳定等对症治疗,研究组患者在上述治疗基础上给予经鼻腔或经气管插管纤维支气管镜引导下支气管肺泡灌洗治疗,比较2组患者支气管肺泡灌洗前和灌洗后24h氧合指数(OI)、动脉血二氧化碳分压(PaCO₂)和动脉血氧饱和度(SaO₂),支气管肺泡灌洗前和灌洗后第1天(D1)、第3天(D3)、第7天(D7)C-反应蛋白(CRP)和PTX3水平及入住重症监护室(ICU)时间。采用SPSS 17.0 统计学软件对数据进行分析。结果 相比治疗前研究组灌洗24h后和对照组OI[(280.2±22.3) vs(180.5±12.9)mmHg(1mmHg＝0.133kPa)；(228.4±18.5) vs(183.4±13.8)mmHg]、PaCO₂[(39.3±5.5) vs(47.7±7.3)mmHg；(43.5±6.2) vs(47.2±7.9)mmHg]和SaO₂[(94.2±2.9)% vs(85.8±5.0)%；(90.4±4.3)% vs(86.9±4.5)%]均改善,研究组灌洗24h后相比对照组OI和SaO₂水平高,PaCO₂水平低,差异均有统计学意义(P＜0.05)。相比支气管肺泡灌洗前,2组患者D1时CRP水平上升,而D3和D7时CRP明显下降,D1、D3和D7时PTX3水平均下降,差异均有统计学意义(P＜0.05)。研究组相比对照组D1、D3和D7时CRP[(108.4±21.5) vs(117.5±30.4)mg/L；(66.9±13.5) vs(74.5±16.3)mg/L；(25.1±9.2) vs(34.6±7.3)mg/L]与PTX3[(18.3±4.0) vs(20.8±3.6)ng/ml；(12.5±3.1) vs(15.9±3.5)ng/ml；(5.2±2.3) vs(9.0±2.9)ng/ml]水平明显下降,差异有统计学意义(P＜0.05)。相比对照组患者,研究组住ICU时间明显缩短[(8.3±3.7) vs(13.5±5.4)d],差异有统计学意义(P＜0.05)。结论 支气管肺泡灌洗治疗重症肺炎合并呼吸衰竭患者可改善呼吸功能,降低PTX3水平,缩短ICU住院时间。

Abstract:

Objective To investigate the effect of bronchoalveolar lavage guided by fiberoptic bronchoscopy on the blood gas indicators and pentraxin-3 (PTX3) level in severe pneumonia patients complicated with respiratory failure. Methods A retrospective analysis was performed on 60 severe pneumonia patients complicated with respiratory failure admitted to our hospital from February 2016 to January 2018. According to undergoing fiberoptic bronchoscopy-guided bronchoalveolar lavage or not, 29 patients were assigned into the study group and 31 patients into the control group. The patients of both groups were given symptomatic treatment, such as assistant ventilation, anti-infective therapy, phlegm resolving treatment and maintenance of internal environment stability. While, the patients of the study group were given bronchoalveolar lavage guided by nasal or tracheal bronchoscopy. Oxygen index (OI), arterial partial pressure of carbon dioxide (PaCO₂) and arterial oxygen saturation (SaO₂) before and 24h after bronchoalveolar lavage, levels of C-reactive protein (CRP) and PTX3 before and 1,3 and 7 d (D1, D3 and D7) after bronchoalveolar lavage, and length and mortality in intensive care unit (ICU) within 30 d were compared between the 2 groups. SPSS statistics 17.0 was used for data analysis.Results After 24h lavage, the study group and control group had their OI [(280.2±22.3) vs (180.5±12.9)mmHg(1mmHg＝0.133kPa), (228.4±18.5) vs (183.4±13.8)mmHg], PaCO₂ [(39.3±5.5) vs (47.7±7.3)mmHg, (43.5±6.2) vs (47.2±7.9)mmHg] and SaO₂ [(94.2±2.9)% vs (85.8±5.0)%, (90.4±4.3)% vs (85.8±5.0)%] improved when compared with the values before bronchoalveolar lavage. The study group had significantly higher OI and SaO₂, but lower PaCO₂ than the control group 24h after lavage (P<0.05). Compared with before bronchoalveolar lavage, CRP level was increased at D1 and then decreased significantly at D3 and D7, and PTX3 level was decreased at D1, D3 and D7 (all P<0.05). The levels of CRP [(108.4±21.5) vs (117.5±30.4)mg/L, (66.9±13.5) vs (74.5±16.3)mg/L, (25.1±9.2) vs (34.6±7.3)mg/L] and PTX3 [(18.3±4.0) vs (20.8±3.6)ng/ml, (12.5±3.1) vs (15.9±3.5)ng/ml, (5.2±2.3) vs (9.0±2.9)ng/ml] were obviously lower in the study group at D1, D 3 and D7 than in the control group (P<0.05). The length of ICU stay was remarkably shorter in the study group than in the control group [(8.3±3.7) vs (13.5±5.4)d, P<0.05]. Conclusion Bronchoalveolar lavage can improve respiratory function, reduce PTX3 level and shorten ICU stay length in severe pneumonia patients complicated with respiratory failure.