支气管肺泡灌洗治疗慢性阻塞性肺疾病患者医院获得性肺炎疗效观察

目的探讨支气管肺泡灌洗对慢性阻塞性肺疾病（COPD）患者医院获得性肺炎（HAP）的治疗价值。方法2008年1月—2012年12月收治COPD发生HAP患者40例,随机分为治疗组（20例）和对照组（20例）。对照组予常规治疗,治疗组在常规治疗基础上给予床旁支气管肺泡灌洗,观察2组的治疗效果。结果治疗后治疗组总有效率（80．O％）高于对照组（45．O％）（P〈0．05）外周血白细胞计数、中性粒细胞比值、SaO2、PaCO2、PaO2组均较治疗前有明显改善（P〈0．05）,且治疗后治疗组均优于对照组（P〈0．01）;治疗组细菌分离率、清除率亦优于对照组,分别为80．0％（16／20）、81．3％（13／16）和40．0％（8／20）、37．5％（3／8）,差异有统计学意义（P〈0．05）。结论支气管肺泡灌洗对治疗COPD患者HAP疗效确切,值得临床推广。

The clinical study of bronchoalveolar lavage in treatment of hospital acquired pneumonia in patients with COPD

Objective To explore the clinical value of bronchoalveolar lavage （BAL） in treatment of hospital acquired pneumonia （HAP） in patients with chronic obstructive pulmonary disease （COPD）. Methods Forty patients diagnosed COPD with HAP were randomly divided into BAL treated group and control group. In the control group, 20 patients received suctioning, empiric anti-infective and sensitive antibiotic based on sputum bacteriology. In the BAL treated group, 20 cases received BAL in addition to suctioning, empiric anti-infective and sensitive antibiotic based on sputum bacteriology. Comparison were made between the 2 groups. Results The effective.rate in the BAL treated group were 80.0%, the ＂control group were 45.0% （ P 〈 0.05）. The BAL treated group＇s WBC, SaO2, PaCO2 and PaO2 improved significantly better than the control group （ P 〈 0. 01 ）. The bacteria isolation rate and clearance rate in the BAL treated group was obviously higher than those in the control group, which were 80.0% （ 16/20）, 81. 3 % （13/16） and 40.0% （8/20） ,37.5 % （3/8）, there were signif- icant difference（ P 〈 0.05）. Conclusion The BAL in the treatment of HAP in patients with COPD is effective, it is worth promoting.