沐舒坦联合肺灌洗治疗重型颅脑损伤患者气管切开术后肺部感染的疗效

目的：探讨沐舒坦联合肺灌洗在重型颅脑损伤患者气管切开术后肺部感染的预防与治疗中的价值。方法将90例患者随机分为观察组和对照组，每组45例。对照组给予纤维支气管镜下肺灌洗，观察组给予沐舒坦联合纤维支气管镜下肺灌洗。比较两组患者气管切开术第1、3、5、7天支气管肺泡灌洗液细胞分类和计数，以及两组患者气管切开后30 d内气管套管拔除例数。记录两组患者气管切开30 d后肺部感染例数、控制例数、控制天数和二次感染病例。结果两组气管切开7 d后的白细胞数和多形核细胞数较第1天均明显减少（P﹤0.05）。观察组分别从第5天和第3天白细胞数和多形核细胞数显著低于对照组，差异有统计学意义（P﹤0.05）。观察组肺部感染率为66.67%（30/45），控制率为86.67%（26/30），与对照组比较差异有统计学意义（P﹤0.05）。气管切开30 d后，观察组和对照组气管套管拔除率分别为60.0%和26.7%，差异有统计学意义（P﹤0.05）。结论沐舒坦联合肺灌洗可以有效预防重型颅脑损伤患者气管切开术后肺部感染的发生，并能更好地控制肺部感染，促进气管修复，具有良好的临床疗效，值得在实践中推广使用。

Effect of mucosolvan combined with lung lavage on the lung infection of 45 patients with severe head injury after trache-otomy

Objective To investigate the value of mucosolvan combined with lung lavage on the prevention and treatment of lung infection in patients with severe traumatic brain injury after tracheotomy. Methods Ninety patients were randomly divided into observation group and control group,with 45 cases in each group. Patients in control group were given lung lavage under branchofiberoscope,and patients in observation group were given mucosolvan combined with lung lavage under branchofiberos-cope. Branchoalveolar lavage cell sorting and counting results on 1st,3th,5th,7th d after tracheotomy and the cases with tra-cheal tube removal within 30 d after tracheotomy,were compared between the two groups. Thirty days after tracheotomy,the number of patients with pulmonary infection and controlled cases,controlled days and the secondary infections cases were recor-ded. Results On the 7th day after tracheotomy,the white blood cell counts and polymorphonuclear cell counts significantly re-duced than those on the 1st day after tracheotomy（P﹤0. 05）. The white blood cell counts and polymorphonuclear cell counts were significant lower in the observation group than those in the control group,from the 5th day and 3th day after tracheotomy, respectively. There were significant differences between the two groups（P﹤0. 05）. In the observation group,the incidence of pulmonary infection was 66. 67%（30/45）,and the control rate was 86. 67%（26/30）,there were significant differences be-tween the two groups（P ﹤0. 05）. After 30 days of tracheotomy,in the observation group,the rate of tracheal sleeve was 60. 0%,and the control rate was 26. 7%, there were significant differences between the two groups （ P ﹤ 0. 05 ）. Conclusion Mucosolvan lavage combined with lung lavage can effectively prevent the pulmonary infection after tracheotomy in patients with severe traumatic brain injury,and better control pulmonary infection,promote the repair of trachea. It has good clin-ical efficacy,and is worth to be promoted in clinics.