【摘要】 目的探讨纤维支气管镜灌洗治疗危重症合并肺部感染患者的疗效。方法选取严重肺部感染合并Ⅰ型或Ⅱ型呼吸衰竭的危重症患者34例,均因病情危重而行有创机械通气和气管切开治疗,在静脉抗生素给药、化痰平喘和全身营养支持等治疗的基础上,采用床边纤维支气管镜灌洗治疗,并比较治疗前后患者体温、痰量及性质、肺部湿口罗音、肺不张者肺段呼吸音情况、血气分析、C反应蛋白(CRP)的变化及胸部X线表现。结果机械通气时间为1~62 d,灌洗时间为机械通气后1~19d,纤维支气管镜灌洗治疗后较治疗前SaO2、Pa(O2)明显提高,Pa(CO2)明显下降,差异均有统计学意义(P<0.05);28例经纤维支气管镜灌洗治疗后肺内感染得到控制,CRP水平明显下降,其中9例肺不张者经纤维支气管镜灌洗治疗后肺完全复张,6例因机械通气时间相对过长(>1周)并发混合感染后治疗失败。结论纤维支气管镜灌洗治疗危重症合并肺部感染患者,可有效切断痰阻塞—炎症加重—痰液雍滞的恶性循环,改善患者肺通气和换气功能,促进肺部炎症的吸收和消退。更多还原

【Abstract】 Objective To observe the effect of bronchofiberscope lavage in patients with critical pulmonary infection.Methods Thirty-four critically ill patients who were supported by invasive mechanical ventilation or long-term tracheotomy as a result of severe pulmonary infection complicated with type Ⅰ or Ⅱ respiratory failure were selected and they were administered bronchofiberscope lavage,antibiotics,mucolytic agent,bronchodilator and general nutritious treatment.Their body temperature,sputum,moist rale,respiratory sound of segmental atelectasis,blood-gas analysis,C-reactive protein(CRP),chest X-ray were compared after treatment.Results Mechanical ventilation lasted 1 to 62 days.Within 19 days after mechanical ventilation,bronchofiberscope lavage was given to the patients.Compared with those before lavage,SaO2 and Pa(O2) were significantly improved(P<0.05) and Pa(CO2) markedly reduced after treatment.28 patients′ pulmonary infection were controlled,with their CRP obviously reduced(P<0.05).And 9 out of them with atelectasis got complete reexpansion.The other 6 patients failed as a result of long term mechanical ventilation complicated with mixed infection.Conclusion Bronchofiberscope lavage treatment is an effective measure to cut the vicious circle of sputum stasis-inflammation aggravated-sputum blockage,to improve lung ventilation and exchange function,and to accelerate the absorption of inflammation for the critically ill patients complicated with pulmonary infection.更多还原