床旁电子支气管镜肺泡灌洗在重症肺部感染治疗中的应用

  目的  探讨电子支气管镜肺泡灌洗治疗重症肺部感染的效果。  方法  选取2018年12月—2021年1月安徽医科大学第四附属医院重症医学科收治的重症肺部感染并发呼吸衰竭患者40例，按照治疗方法分为观察组和对照组，每组20例。对照组采用抗感染、机械通气、吸痰等常规治疗，观察组在常规治疗基础上加用电子支气管镜肺泡灌洗治疗，观察2组临床疗效、血气分析指标、炎症指标及操作安全性。  结果  观察组疗效优于对照组(Z=2.054, P=0.040)。治疗后，与对照组比较，观察组动脉血氧分压[(113.88±17.52)mm Hg vs. (91.36±16.70)mm Hg，P＜0.001，1 mm Hg=0.133 kPa]和氧合指数[(308.42±55.25)mm Hg vs. (258.43±64.02)mm Hg，P=0.012]更高, 动脉血二氧化碳分压[(34.33±3.92)mm Hg vs. (37.37±2.72)mm Hg，P=0.007]更低。观察组的白细胞计数[(7.42±1.82)×109/L]、超敏C反应蛋白[22.43(11.66，31.02)mg/L]、降钙素原[0.32(0.14, 0.44) ng/mL]均低于对照组[(9.66±2.57)×109/L，44.79(16.03，87.01)mg/L，0.73(0.17, 2.29)ng/mL，均P＜0.05]。观察组支气管肺泡灌洗操作过程中未出现严重不良反应。  结论  支气管镜肺泡灌洗操作安全，可改善患者肺功能，对肺部感染控制疗效显著。 

Application of bedside electronic bronchoscopic alveolar lavage in the treatment of severe pulmonary infection

  Objective  To investigate the effect of electronic bronchoscopic alveolar lavage in the treatment of severe pneumonia.  Methods  Forty patients with severe pulmonary infection complicated with respiratory failure admitted to the Intensive Care Department of the Fourth Affiliated Hospital of Anhui Medical University from December 2018 to January 2021 were selected. They were divided into the observation group and control group according to treatment methods, with 20 patients in each group. The control group was treated with anti-infection, mechanical ventilation, sputum aspiration and other conventional treatments, whereas the observation group was treated with electronic bronchoscopic alveolar lavage on the basis of conventional treatment. The clinical efficacy, blood gas analysis, inflammatory indicators and operation safety of the two groups were observed.  Results  The curative effect of the observation group was higher than that of the control group(Z=2.054, P=0.040). After treatment, the observation group had higher arterial partial pressure of oxygen [(113.88±17.52) mm Hg vs. (91.36±16.70) mm Hg, P < 0.001, 1 mm Hg=0.133 kPa] and oxygenation index [(308.42±55.25) mm Hg vs. (258.43±64.02) mm Hg, P=0.012] and lower arterial partial pressure of carbon dioxide [(34.33±3.92) mm Hg vs. (37.37±2.72) mm Hg, P=0.007] than the control group. The white blood cell count [(7.42±1.82)×109/L], high-sensitivity C-reactive protein [22.43 (11.66, 31.02) mg/L] and procalcitonin [0.32 (0.14, 0.44) ng/mL] in the observation group were lower than those in the control group [(9.66±2.57)×109/L, 44.79 (16.03, 87.01) mg/L and 0.73 (0.17, 2.29)ng/mL, respectively, all P < 0.05]. There were no serious adverse reactions during bronchoalveolar lavage in the observation group.  Conclusion  Bronchoscopic alveolar lavage is safe, can improve lung function and has significant effect on the control of pulmonary infection.