床边纤维支气管镜在呼吸机相关性肺炎治疗中的价值

目的探讨床边纤维支气管镜在呼吸机相关性肺炎(ventilation-associated pneumonia,VAP)治疗中的价值。方法选择2012年1月—2013年1月收治的VAP患者38例,随机分为A组20例和B组18例。两组在使用有创机械通气期间,对患者进行常规治疗及翻身、叩背等;在重症监护期间均给予积极抗感染、化痰、维持内环境稳定、营养支持等综合治疗。同时,B组患者在入院后即给予床边纤维支气管镜吸痰,隔日1次,且必要时给予生理盐水肺泡灌洗治疗。两组治疗结束时间为终止有创机械通气时间(撤机时)。两组在治疗前及治疗第3、6天及撤机时测定血清中PaO2、WBC、C反应蛋白(C reaction protein,CRP)、降钙素原(procalcitonin,PCT)。计量资料采用单因素方差分析,P<0.05为差异有统计学意义。结果 A组治疗后第3天PaO2、WBC、CRP、PCT分别为(62.35±6.91)mm Hg(1 mm Hg=0.133 kPa)、(16.62±3.13)×109/L、(160.37±13.22)mg/L、(4.24±0.42)μg/L,治疗后第6天分别为(66.63±7.42)mm Hg、(14.58±2.11)×109/L、(124.13±11.18)mg/L、(2.22±0.14)μg/L;B组治疗第3天分别为(67.80±7.85)mmHg、(12.82±2.14)×109/L、(120.78±11.54)mg/L、(2.12±0.12)μg/L,治疗第6天分别为(70.16±8.84)mmHg、(10.02±2.75)×109/L、(86.68±9.32)mg/L、(0.95±0.09)μg/L。两组比较差异均有统计学意义(均P<0.05)。有创机械通气时间A组(13.72±3.60)d,B组(9.32±2.86)d,两组比较差异有统计学意义(P<0.05)。结论在VAP治疗中应用床边纤维支气管镜有助于肺内分泌物的排出、炎症指标的控制及血氧水平的提升,并可缩短有创机械通气时间。

Clinical value of bedside fiberoptic bronchoscopy in treating ventilator- associated pneumonia

Objective To investigate the clinical value of bedside fiberoptic bronchoscopy in treating ventilator-associated pneu- monia（VAP）.Methods Thirty-eight cases of VAP treated from January 2012 to January 2013 were selected and randomly divided into two groups：group A（n=20） and group B（n=18）.During the time when invasive mechanic ventilation was applied to both groups,con- ventional treatment was given by one to two nurses,including turning over,knocking back,sputum suction.When in ICU,comprehen- sive treatment was given including anti-infection,facilitating expectoration,maintenance of homeostasis and nutrition support.For group B,sputum suction with bedside fiberobronchoscope was given every other day on admission and bronchoalveolar lavage when necessary.Mechanical ventilation lasted to the end of treatment.Both groups were measured for serum PaO2,WBC count,CRP and PCT before treatment,the 3rd and 6th day after treatment, and the day when mechanical ventilation is terminated.Measurement data were processed with one-way ANOVA,the result of P〈0.05 was considered to be statistically significant.Results On the 3th day after treatment,serum PaO2,WBC,CRP and PCT were （62.35 ± 6.91）mm Hg（1 mm Hg=0.133 kPa）,（16.62 ± 3.13） ×10^9/L,（160.37 ± 13.22） mg/L,and （4.24 ± 0.42）μg/L respectively in group A;on the 6th day after treatment,they were （66.63 ± 7.42） mm Hg,（14.58 ± 2.11）×10^9/L,（124.13 ± 11.18）mg/L and（2.22 ± 0.14） μg/L respectively.For control group,serum PaO2,WBC,CRP and PCT were （67.80 ± 7.85） mm Hg,（12.82 ±2.14） ×10^9/L,（120.78 ± 11.54）mg/L and （2.12 ±0.12） g/L respectively on the 3th day after treatment; they were （70.16 ± 8.84）mm Hg,（10.02 ± 2.75）×10^9/L,（86.68 ± 9.32） mg/L and（0.95 ± 0.09）μg/L respectively on the 6th day after treatment The difference between the two groups was statistically significant（P〈0.05）.The duration of mechanical ventilation was （13.72 ± 3.60）d in group A and（9.32 ± 2.86）d in group B,and there was significant difference between two groups（P〈0.05）.Conclusion Bedside fiberoptic bronchoscopy for VAP facilitates the discharge of pulmonary secretions,contributes to the control of inflammatory markersin patients with VAP and shortens the duration of mechanical ventilation.