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目的观察并探讨床旁纤支镜联合氨溴索肺泡灌洗在排痰障碍的老年卒中相关性肺炎(stroke-associated pneumonia,SAP)中的临床效果。方法选取2012年1月—2016年12月SAP住院患者120例,随机分为观察组和对照组,各60例。对照组给予常规对症治疗,观察组在对照组基础上给予床旁纤支镜联合氨溴索肺泡灌洗治疗。对比两组治疗前、治疗第3、7及14天动脉血气指标、临床肺部感染评分(clinical pulmonary infection score,CPIS)及外周血炎性因子指标。比较采用重复测量方差分析及t检验,P<0.05为差异有统计学意义。结果治疗3~7 d后,观察组PaO_2(78.50±11.25)mm Hg高于对照组(65.46±11.16)mm Hg,PaCO_2(43.56±3.52)mm Hg低于对照组(53.35±4.85)mm Hg,比较差异有统计学意义(均P<0.05);治疗7~14 d后观察组IL-6(35.40±11.31)pg/ml、hs-CRP(5.86±1.57)mg/L、PCT(0.31±0.15)ng/ml、TNF-α(33.21±3.78)pg/ml均低于对照组[(42.21±13.08)pg/ml、(12.15±2.45)mg/L、(0.86±0.13)ng/ml、(53.42±9.63)pg/ml],观察组CPIS评分(1.05±0.38)分、住院天数(16.77±1.63)d少于对照组[(2.25±0.88)分、(23.50±3.06)d],比较差异有统计学意义(均P<0.05);观察组未发现不良反应。结论老年卒中相关性肺炎患者在抗感染、氧疗等常规治疗基础上使用床旁纤支镜联合氨溴索肺泡灌洗术,可减轻炎性反应对肺组织的损伤,改善患者肺功能,缩短住院天数。
Objective To observe and discuss the clinical effect of bedside fiberoptic bronchoscopy combined with ambroxol alveolar lavage in stroke-associated pneumonia (SAP). Methods From January 2012 to December 2016, 120 hospitalized patients with SAP were randomly divided into observation group and control group, 60 cases each. The control group was given conventional symptomatic treatment. The observation group was given bedside bronchoscopy and ambroxol alveolar lavage on the basis of the control group. The arterial blood gas indexes, clinical pulmonary infection score (CPIS) and peripheral blood inflammatory factors were compared between the two groups before treatment, on the 3rd, 7th and 14th days of treatment. Comparison of repeated measures ANOVA and t test, P <0.05 for the difference was statistically significant. Results After 3 to 7 days of treatment, the PaO_2 (78.50 ± 11.25) mm Hg in the observation group was significantly higher than that in the control group (65.46 ± 11.16 mm Hg, PaCO_2 (43.56 ± 3.52) mmHg, compared with 53.35 ± 4.85 mm Hg in the control group The levels of IL-6 (35.40 ± 11.31) pg / ml and hs-CRP (5.86 ± 1.57) mg / L and PCT (0.31 ± 0.15 (42.21 ± 13.08) pg / ml, (12.15 ± 2.45) mg / L, (0.86 ± 0.13) ng / ml, 53.42 ± 9.63) pg / ml]. The CPIS score of the observation group was 1.05 ± 0.38 and the length of hospital stay was (16.77 ± 1.63) d less than that of the control group [(2.25 ± 0.88) and (23.50 ± 3.06) d, respectively) There were statistical significance (all P <0.05); no adverse reactions were observed in the observation group. Conclusion Stroke-associated pneumonia patients with bedside paraplegia and Ambroxol bronchoalveolar lavage can reduce the damage of lung tissue, improve lung function and shorten the pulmonary function in patients with stroke-associated pneumonia The number of days in hospital.