支气管肺泡灌洗治疗支气管扩张合并感染的临床疗效

目的探讨支气管肺泡灌洗(BAL)对治疗支气管扩张合并感染患者的临床疗效。方法选择明确诊断为支气管扩张合并感染的患者102例,按照自愿的原则,其中46例分为对照组,行常规治疗及引流排痰治疗;56例分为观察组,行常规治疗及支气管肺泡灌洗治疗,4周后比较两组治疗后PaO2、PaO2/F iO2、致病菌清除及临床疗效情况。结果观察组与对照组治疗4周后,在PaO2、PaO2/F iO2、致病菌清除及临床疗效比较差异有统计学意义(P0.05)。结论支气管肺泡灌洗在治疗支气管扩张合并感染时能显著提高疗效,应作为治疗支气管扩张合并感染的首选治疗方法。     

支气管肺泡保留灌洗治疗在支气管扩张合并感染中的应用

目的:观察支气管肺泡保留灌洗治疗在支气管扩张合并感染患者中的疗效。方法:将55例支气管扩张合并感染的患者随机分为两组:对照组26例,采用常规治疗;治疗组29例,在常规治疗基础上,给予支气管肺泡保留灌洗治疗,观察两组患者的疗效。结果:治疗组疗效明显优于对照组(P<0.01),仅3例出现术后发热,1d后恢复正常,1例术后出现呼吸困难,经BIPAP呼吸机辅助呼吸1d后好转。结论:支气管肺泡保留灌洗治疗支气管扩张合并感染的患者,具有疗效好,疗程短,安全可靠、经济的优点。     

纤维支气管镜支气管肺泡灌洗联合局部加注抗生素治疗老年重症支气管扩张合并感染患者的临床效果

目的观察纤维支气管镜支气管肺泡灌洗联合局部加注抗生素治疗老年重症支气管扩张合并感染患者的临床效果。方法采集我院呼吸内科2017年7月至2018年7月收治的120例重症支气管扩张并感染的老年患者的临床资料,按随机数字表将其分为观察组和对照组,每组60例,对照组进行常规治疗,观察组在常规治疗基础上行纤支镜支气管肺泡灌洗+抗生素局部加注治疗。比较两组的临床疗效、血气指标及炎症因子水平。结果观察组的治疗总有效率显著高于对照组(P<0.05)。治疗后,两组的PaO2、SaO2水平均升高,PaCO2、hs-CRP、TNF-α、IL-4、IL-23水平均降低,且观察组优于对照组(P<0.05)。结论采取纤支镜支气管肺泡灌洗联合局部加注抗生素治疗老年重症支气管扩张合并感染的效果显著,既能提高疗效、改善血气指标,又能减轻炎症反应。     

支气管肺泡灌洗治疗支气管扩张合并感染的疗效分析

目的 :探讨支气管肺泡灌洗 (BAL)治疗支气管扩张合并感染的疗效及其安全性。方法 :将 91例支气管扩张合并感染的病人随机分为 4组 :门诊治疗组 (A组 ) 2 6例 ,门诊对照组 (B组 ) 2 3例 ,住院治疗组 (C组 ) 2 2例和住院对照组 (D组 ) 2 0例。对照组采用常规治疗 ,治疗组在常规治疗的基础上 ,加用BAL治疗。观察 4组患者的疗效。结果 :A组疗效明显优于B组 (P <0 .0 1) ,C组疗效也明显高于D组 (P <0 .0 1) ,而A组与C组的疗效比较 ,差异无显著性 (P >0 .0 5 )。治疗过程中 ,有时出现短暂的动脉血氧饱和度下降和心率增快。大部分病例经 1～ 2次BAL治疗后 ,症状消失。结论 :BAL治疗支气管扩张感染 ,具有提高疗效 ,缩短疗程 ,安全和可靠的优点 ,值得在门诊病人中推广。     

内科常规治疗联合支气管肺泡灌洗治疗支气管扩张并感染

目的观察内科常规治疗联合支气管肺泡灌洗治疗支气管扩张并感染的临床疗效。方法 100例支气管扩张并感染的患者随机分为两组,每组各50例。对照组予抗感染、祛痰等内科常规治疗;在对照组治疗基础上加用支气管肺泡灌洗术(bronchoalveolar lavage,BAL)。比较两组患者治疗前后临床症状体征、白细胞(WBC)计数、C反应蛋白(CRP)水平、简化的临床肺部感染评分(simplified clinical pulmonary infection score,CPIS)、抗生素使用时间、住院时间及治疗总有效率。结果患者临床症状体征改善更快,且WBC计数、CRP水平、CPIS评分等感染指标及抗生素使用时间、住院时间优于对照组,差异均有统计学意义(P0.05);实验组、对照组总有效率比较(96%/84%),差异有统计学意义(P0.05)。不良反应发生率(18%/16%)组间比较,差异无统计学意义(P0.05)。结论内科常规治疗联合支气管肺泡灌洗治疗支气管扩张并感染同常规治疗比较,疗程更短,疗效更佳。     

鱼腥草注射液肺泡灌洗治疗支气管扩张合并肺部感染20例疗效观察

目的:观察鱼腥草注射液肺泡灌洗治疗支气管扩张合并肺部感染疗效。方法:39 例患者随机分为2 组,治疗组20 例用鱼腥草注射液经纤维支气管镜肺泡灌洗,对照组19 例用蒸馏水灌洗,2 组患者均每周灌洗2 次,4 次为1 个疗程;患者均同时服用按中医辨证施治的中药汤剂,每日1 剂。结果:治疗组显效率为75.0% ,对照组显效率为36.8% ,治疗组疗效优于对照组(P< 0.05)。治疗组肺活量(VC)和 1 秒钟用力呼气容量(FEV1)的改善率均显著优于对照组(P< 0.001)。结论:鱼腥草注射液有较好的局部抗炎效果,用于支气管肺泡灌洗治疗支气管扩张合并感染疗效确切,无不良反应。     

支气管肺泡灌洗氨溴索治疗支气管扩张感染的疗效观察

目的:探讨支气管肺泡灌洗氨溴索治疗支气管扩张感染的临床疗效。方法:将2011年6月~2013年12月我院救治的100例支气管扩张感染患者随机等分为观察组和对照组。观察组给予支气管肺泡灌洗氨溴索治疗,对照组给予生理盐水灌洗治疗,对两组临床疗效进行对比。结果:灌洗治疗后观察组患者临床疗效优于对照组,住院时间短于对照组,治疗后血氧饱和度以及动脉氧分压优于对照组,两组比较均有统计学差异(P0.05)。结论:支气管肺泡灌洗氨溴索治疗支气管扩张感染,临床疗效显著,无明显不良反应,值得临床广泛推广。     

纤维支气管镜肺泡灌洗治疗支气管扩张合并感染的疗效

目的分析纤维支气管镜肺泡灌洗治疗支气管扩张合并感染的疗效及对血清TNF-α和hs-CRP含量的影响。方法选择在该院接受住院治疗的支气管扩张合并感染患者作为研究对象,随机分为接受常规治疗的对照组以及接受纤维支气管镜肺泡灌洗治疗的观察组,比较两组患者的临床症状缓解时间,血清TNF-α和hs-CRP水平与血气水平等差异。结果观察组患者接受纤维支气管镜肺泡灌洗治疗后的发热、咳嗽咳痰及肺部湿啰音等症状体征缓解时间明显短于对照组患者(P0.05)。观察组患者接受治疗后的血清TNF-α和hs-CRP水平值明显低于对照组患者(P0.05)。观察组患者治疗后的Pa O2和Pa O2/Fi O2水平高于对照组;Pa CO2水平低于对照组患者(P0.05)。结论纤维支气管镜肺泡灌洗治疗可以促进支气管扩张合并感染患者的早期康复,优化血清炎症因子水平,改善有效通气状态。     

应用支气管肺泡灌洗治疗金葡菌肺炎疗效分析

目的 :观察应用支气管肺泡灌洗术治疗金葡菌肺炎的疗效。方法 :将 4 6例金葡菌肺炎患者随机分为治疗组与对照组 ,治疗组在常规抗生素等治疗的基础上应用纤支镜支气管肺泡灌洗术治疗 ,对照组仅常规抗生素等治疗。结果 :治疗组与对照组的平均住院日分别为 2 1.3d和 35 .6d(P <0 .0 1)。治疗组与对照组的治愈率分别为 96 .0 % ,76 .2 % (P <0 .0 5 )。结论 :应用纤支镜支气管肺泡灌洗治疗金葡菌肺炎疗效显著。     

肺泡灌洗加体位引流预防支气管扩张再感染与咯血的研究

目的 研究肺泡灌洗加体位引流预防支气管扩张再感染与咯血的临床疗效。方法 将260例支气管扩张患者随机分为A、B、C、D4组，每组65例。A组予以肺泡灌洗加体位引流治疗；B组采用肺泡灌洗治疗；C组采用体位引流治疗；D组常规治疗组在急性感染与咯血控制后不做任何处理。4组均观察5年。结果 A、B、C、D4组预防支气管扩张再感染与咯血的5年复发率分别为10．77％、67.70％、26．16％和69．23％，A组与B组、C组、D组疗效比较差异有显著性（P〈0．01），C组与B组、D组疗效比较差异有显著性（P〈0．01），而B组与D组疗效比较差异无显著性（P〉0．05）。结论 肺泡灌洗加体位引流预防支气管扩张再感染与咯血的疗效显著，且安全，患者易接受，值得临床推广应用。     

Effects of bronchoalveolar lavage volume on arterial oxygenation in mechanically ventilated patients with pneumonia

OBJECTIVE: To assess the effect of bronchoalveolar lavage (BAL) volume on arterial oxygenation in critically ill patients with pneumonia. DESIGN: Randomized clinical comparison. SETTING: Six-bed respiratory intensive care unit of a 850-bed tertiary care university hospital. PATIENTS: Thirty-seven intubated and mechanically ventilated patients with clinical suspicion of pneumonia. INTERVENTIONS: Bronchoscopically guided protected specimen brush (PSB) followed by either a "high volume" BAL (n = 16, protected catheter, mean volume: 131 +/- 14 ml) or a "low volume" BAL (n = 21, protected double-plugged catheter, 40 ml volume for all patients). MEASUREMENTS: Arterial oxygen tension/fractional inspired oxygen (PaO2/FIO2) and mean arterial pressure (MAP) before and up to 24 h after the intervention. Bacterial growth in quantitative cultures. Analysis of variance for repeated measurements with inter-subject factors. RESULTS: All patients showed a lower PaO2/FIO2 ratio and higher MAP after the diagnostic procedure, without differences between the study arms (p = 0.608 and p = 0.967, respectively). Patients with significant bacterial growth (p = 0.014) and patients without preemptive antibiotic (p = 0.042) therapy showed a more profound and longer decrease in arterial oxygenation after the diagnostic procedure. CONCLUSIONS: A decrease in the PaO2/FIO2 ratio was observed in all patients after a combined diagnostic procedure, independent of the BAL volume used. A significant bacterial burden recovered from the alveoli and no preemptive antibiotic therapy were associated with a larger and longer-lasting decrease in arterial oxygenation.     

支气管肺泡灌洗结合病灶局部给药治疗高龄呼吸机相关肺炎的疗效观察

目的 探讨纤维支气管镜（纤支镜）支气管肺泡灌洗（bronchoalceo larlavage，BAL）结合病灶局部给药治疗高龄呼吸机相关肺炎的疗效观察。方法 将50例因呼吸衰竭进行机械通气治疗合并VAP的高龄患者随机分为对照组（综合治疗26例）和BAL组（BAL＋病灶局部给药＋综合治疗24例）。治疗后对肺部感染的临床症状、体征、外周血白细胞计数、痰细菌培养、肺部炎性病变吸收情况进行分析。结果 BAL组临床治愈率（79．2％）较对照组（34．6％）明显提高（P〈0．05），有效率（97．1％）明显大于对照组（73．1％）（P〈0．05）。结论 纤支镜经Swivel adapter接头套管导管进镜进行BAL并结合局部给药治疗老年高龄VAP为一种安全、方便、快捷、有效的治疗方法。     

Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns

Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality for patients with burns. In nonburn populations, bronchoalveolar lavage (BAL) excludes other pathology such as systemic inflammatory response syndrome. We hypothesized that BAL would decrease our false-positive VAP rate. All ventilated patients with burn injury who were admitted to our institution from July 2000 through June 2003 were included. After June 2001, BAL was used to make the diagnosis of VAP, with > or =10(4) organisms considered a positive result. Fifty patients met criteria for VAP, 21 in the pre-BAL period and 29 in the BAL period. Six patients (21%) in the BAL group had quantitative cultures <10(4) and were not treated. The outcomes for these patients were not different than those treated for VAP. There were no differences in age, TBSA size, antibiotic use, or ventilator days for the pre-BAL or BAL groups, although the pneumonia rate was lower for the BAL time period. The use of BAL eliminated the unnecessary antibiotic treatment of 21% of patients in the BAL time period and was associated with a lower rate of VAP.     

Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates

OBJECTIVE: To analyze the impact of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on guiding the treatment and intensive care unit (ICU) clinical outcome in neutropenic patients with pulmonary infiltrates admitted to the ICU. DESIGN: Prospective collection of data. SETTING: Medical ICU in a teaching hospital. PATIENTS: During a 6-yr period, we analyzed the results of 93 fiberoptic bronchoscopies plus BALs performed in 93 consecutive neutropenic ICU patients. We separated the patients into two groups according to the cause of neutropenia (high-dose chemotherapy [n = 41] or stem cell transplantation [SCT; n = 52]). RESULTS: Of the 93 BALs, 53 were performed to evaluate diffuse infiltrates and 42 were performed on mechanically ventilated patients. Forty-nine percent of BALs (46 patients) were diagnostic, with a significantly better yield in ICU patients with high-dose chemotherapy-induced neutropenia (26 of 41 BALs). The number of cases of proven infectious pneumonia was significantly higher in this group of ICU neutropenic patients. In patients who underwent SCT, diffuse infiltrates were statistically correlated with a negative result of BAL. Twenty-six patients who underwent diagnostic BALs changed therapy. Sixteen complications (17%) occurred with only two intubations. The overall mortality rate in the ICU and the mortality rate in mechanically ventilated neutropenic patients were 71% and 93%, respectively. In neutropenic patients who underwent SCT, the mortality rate was statistically higher in patients in whom no diagnosis was established. Patients who had a diagnostic BAL that changed therapy did not have an increased probability of survival compared with patients who had a BAL that did not change therapy. CONCLUSIONS: The use of routine diagnostic BAL in ICU neutropenic patients with pulmonary infiltrates is difficult to establish, even if BAL is helpful in the management of these critically ill patients. BAL in our ICU neutropenic patient population had an acceptable overall diagnostic yield (49%), which was higher in ICU patients with chemotherapy-induced neutropenia. Nevertheless, in the ICU, if BAL had a low complication rate, it had infrequently led to changed treatment and was not associated with improved patient survival.     

Diagnosis of ventilator-associated pneumonia

Introduction

Ventilator-associated pneumonia (VAP) is difficult to diagnose. Recent data suggest quantitative endotracheal aspirate (ETA) may be noninferior diagnostically to quantitative bronchoalveolar lavage (BAL). We hypothesized this would be the case.

Methods

Blind quantitative ETA and BAL were performed on 150 consecutive ventilated patients with suspected VAP in a prospective single-centre medical intensive care unit study over a 2-year inclusion period. Patients were either antibiotic-naive or antibiotic-free for 72 hours. Diagnostic yield, Gram stain and culture results, and impact on antibiotic therapy were assessed. The independent impact of a positive BAL or ETA result on ventilator settings and 28-day mortality was calculated. The BAL/ETA safety was assessed hemodynamically.

Results

Bronchoalveolar lavage had significantly higher diagnostic yield (49.3% vs 34.0%, P = .01), more frequent impact on antibiotic therapy (usually de-escalation) (48.0% vs 32.7%, P = .01), and greater sensitivity (64.1% vs 42.6%, P = .0003) than ETA. There was moderate intertest agreement and no difference in specificity and positive and negative predictive values. A positive BAL or ETA result did not independently alter the frequency of ventilator changes or 28-day mortality. Both procedures were well tolerated.

Conclusion

Quantitative BAL is safe and has greater diagnostic utility than ETA for VAP facilitates de-escalation. This study provides support for quantitative BAL in VAP diagnosis.     

支气管肺泡灌洗治疗高龄老人肺部感染

目的了解支气管肺泡灌洗（BAL）治疗高龄老人肺部感染的作用。方法对43例高龄老人进行BAL治疗，观察首次行BAL治疗前及BAL治疗后1、6和24h的血气分析。在行BAL治疗后观察患者临床表现、X线胸片、致病菌被清除情况。结果首次行BAL治疗前与BAL后1h相比，pH、PO2、PCO2差异无显著性；而首次行BAL治疗前分别与BAL后6h、24h相比，pH、PO2、PCO2差异均有显著性。无1例在BAL治疗过程中死亡。BAL治疗总有效率达81．4％。结论BAL治疗高龄老人肺部感染是安全有效的，通过BAL治疗，低氧血症和二氧化碳潴留得到明显改善，呼吸衰竭得到纠正，肺部感染得到控制。     

内镜与开腹手术在治疗胆总管结石中的对比研究

目的研究内镜与开腹手术在治疗胆总管结石病人中各自的优缺点。方法对内镜治疗和同期开腹手术治疗的各30例胆总管结石病人资料进行回顾性研究,比较两组手术前后的相关指标。结果开腹手术组术后1 d血清转氨酶、外周血白细胞总数明显高于内镜组(P<0.01)。内镜组手术前后体温无明显变化,开腹手术组体温则明显升高,剖腹手术组术后3 d内平均体温明显高于内镜治疗组。内镜组术后抗菌药物使用时间、恢复饮食时间和平均住院时间较开腹组显著缩短。结论内镜治疗胆总管结石与开腹手术相比具有恢复快、痛苦小、并发症少的优点,但其一次结石取净率较开腹手术低,需要改进器械,提高技术来完善。内镜治疗胆总管结石具有良好的应用前景。     

Cytokine expression in severe pneumonia: a bronchoalveolar lavage study.

OBJECTIVE: To assess the cytokine expression (tumor necrosis factor-alpha [TNF-alpha], interleukin [IL]-1beta, and IL-6) in severe pneumonia, both locally (in the lungs) and systemically (in blood). DESIGN: Prospective sequential study with bronchoalveolar lavage (BAL) and blood sampling. SETTING: Six-bed respiratory intensive care unit of a 1,000-bed teaching hospital. PATIENTS: Thirty mechanically ventilated patients (>48 hrs) were allocated to either the pneumonia group (n = 20) or a control group (n = 10). INTERVENTIONS: Protected specimen brush and BAL samples for quantitative cultures, and serum and BAL fluid TNF-alpha, IL-1beta, and IL-6 levels were measured on days 1, 3, and 7. In the control group, the procedure was done on day 1 only. MEASUREMENTS AND MAIN RESULTS: Serum TNF-alpha levels were significantly higher in patients with pneumonia compared with controls (35 +/- 4 vs. 17 +/- 3 pg/mL, respectively, p = .001). IL-6 levels in serum and BAL fluid were higher in pneumonia than in control patients (serum, 837 +/- 260 vs. 94 +/- 35 pg/mL, respectively, p = .017; BAL fluid, 1176 +/- 468 vs. 234 +/- 83 pg/mL, respectively, p = .05). On days 1, 3, and 7 in patients with pneumonia, IL-1beta levels turned out to be higher in BAL fluid than in serum (71 +/- 17 vs. 2 +/-1 pg/mL on day 1; 49 +/- 8 vs. 6 +/- 2 pg/mL on day 3; and 47 +/- 16 vs. 3 +/- 2 pg/mL on day 7 for BAL fluid and serum, respectively, p < .05). No significant correlation between BAL fluid cytokine levels and lung bacterial burden was shown in presence of antibiotic treatment. Although no clear relationship was found between BAL fluid and serum cytokines and mortality, there was a trend toward higher serum IL-6 levels in nonsurvivors (1209 +/- 433 pg/mL) with pneumonia compared with survivors (464 +/- 260 pg/mL). In addition, serum TNF-alpha and IL-6 correlated with multiple organ failure score (r2 = .36, p = .004 for both) and with lung injury score (r2 = .30, p = .01, and r2 = .22, p = .03, for TNF-alpha and IL-6, respectively). CONCLUSIONS: The present study describes the lung and systemic inflammatory response in severe pneumonia. The lung cytokine expression seems to be independent from the lung bacterial burden in the presence of antibiotic treatment. Because of the limited sample size, we did not find a clear relationship between serum and BAL fluid cytokine levels and outcome.