纤维支气管镜下沐舒坦肺泡灌洗对重症脑卒中患者肺部感染的疗效

目的观察纤维支气管镜(纤支镜)下沐舒坦肺泡灌洗对重症脑卒中患者肺部感染的治疗效果。方法 选择重症脑卒中合并肺部感染可行纤支镜肺泡灌洗的患者42例，随机分为生理盐水组与沐舒坦组各21例。全部患者入重症监护室（ICU）后进行经验性抗感染、扩张支气管、雾化吸入及静脉滴注沐舒坦等治疗。记录患者开始治疗前APACHEⅡ评分、GCS评分、C反应蛋白（CRP）、 临床肺部感染评分（CPIS），比较2组肺泡灌洗次数、每次肺泡灌洗时间、吸出痰液量、住ICU天数、使用呼吸机时间及灌洗前后CPIS分值。结果2组患者年龄、性别、开始肺泡灌洗前的GCS评分、APACHEⅡ评分、CRP值比较,差异无统计学意义(P＞0.05)。沐舒坦组与生理盐水组肺泡灌洗次数、平均每次灌洗时间和灌洗痰液量比较，差异无统计学意义（P=0.05）；沐舒坦组使用呼吸机时间(63.57±21.94) h及住ICU时间(6.24±1.04) d少于生理盐水组［分别为（88.24±21.35）h和（7.95±1.36）d］，差异有统计学意义（分别t=-3.69，P=0.00；t=-4.58，P=0.00）。灌洗后第3、4天，沐舒坦组CPIS分值（分别为2.36±0.77、2.17±0.81）较生理盐水组（分别为4.16±0.86、3.54±1.09）低,且差异有统计学意义（分别t=3.60，P=0.00；t=2.25，P=0.03）。结论纤支镜下沐舒坦肺泡灌洗能促进脑卒中患者肺部感染的康复。

Effect of mucosolvan bronchoalveolar lavage on stroke patients with pulmonary infection

Objective To evaluate the effect of mucosolvan bronchoalveolar lavage on stroke patients with pulmonary infection. Methods Forty two stroke patients with pulmonary infection were randomly divided into two groups, normal saline group and mucosolvan group were 21 cases respectively. All patients were treated with antiinfection, bronchodilatation, aerosol inhalation and intravenous drip of mucosolvan in ICU. Observed indicators included acute physiological and chronic health evaluation （APACHE Ⅱ） score, Glasgow coma scale （GCS） ,C-reac tion protein （CPR）, and clinic pulmonary infection score （CPIS） in all cases. The number of alveolar lavage , the average duration of lavage, aspirated sputum volume, the days in ICU , duration of using ventilators and CPIS were compared before and after lavage between two groups. Results There were no significant difference in age, gender, C, CS score, APPACHE Ⅱ score and CRP before lavation in both groups（P〉0.05）, and there was also no statisti cal difference in lavage number, average duration of lavage, and aspirated sputum volume between two groups （P = 0. 05）; mucosolvan group had less time on the ventilator （ 63.57 ±21.94]h ）and less day to stay in ICU（6. 24 ±1.04]d） than saline group（88. 24 ± 21.35]h, 7. 95 ± 1.36]d ,respectively） （t = - 3.69,P= 0. 00;t = - 4. 58,P = 0. 00） ; at the 3rd and 4th day after lavage , CPIS in mucosolvan group was （2. 36 ± 0. 77） and （ 2.17± 0. 81） respectively, which were significantly lower than saline group（4. 16 ± 0. 86], 3.54 ±1.09], respectively） （t = 3. 60, P = 0. 00; t = 2. 25, P = 0. 03）. Conelusion Mucosolvan bronchoalveolar lavage can promote stroke patients to recov er from pulmonary infection.