【摘要】 目的探讨机械振动排痰联合纤维支气管镜治疗重症肺炎的临床疗效。方法选择2017年10月至2019年10月期间高要区人民医院重症医学科收治的82例重症肺炎患者为研究对象,根据随机数表法将患者分为观察组42例和对照组40例。所有患者均合并呼吸衰竭且接受机械通气治疗,对照组采用纤维支气管镜肺泡灌洗治疗,观察组在纤支镜治疗前先应用振动排痰治疗。比较两组患者的临床疗效、治疗前及治疗后2 h的氧合指数（PaO₂/FiO₂）,呼吸做功（WOB）和动态顺应性（Cydn）,同时比较两组患者的机械通气时间、住ICU时间、28 d死亡率。结果治疗后,观察组患者的PaO₂/FiO₂、Cdyn水平分别为382.47±60.42、（38.43±4.50） mL/cmH₂O,明显高于对照组的351.37±44.31、（31.82±8.64） m L/cmH₂O,WOB水平为（0.67±0.24） J/L,明显低于对照组的（0.95±0.36） J/L,差异均有统计学意义（P<0.05）;观察组患者的机械通气时间和住ICU时间分别为（6.07±1.12） d、（7.96±2.38） d,明显少于对照组的（8.46±2.25） d、（11.85±3.67） d,差异均有统计学意义（P<0.05）;观察组和对照组患者住院28 d死亡率分别为4.76%和7.50%,差异无统计学意义（P>0.05）;观察组患者治疗总有效率为88.10%,明显高于对照组的72.50%,差异有统计学意义（P<0.05）。结论机械振动排痰联合纤维支气管镜治疗重症肺炎,对患者肺泡氧合功能、呼吸功能功能的改善更加有利,可以缩短患者的病程,提高临床疗效。更多还原

【Abstract】 Objective To investigate the clinical effect of mechanical vibration expectoration combined with fiberbronchoscope in the treatment of severe pneumonia. Methods Eighty-two patients with severe pneumonia in Department of Critical Medicine, Zhaoqing Gaoyao District People’s Hospital from October 2017 to September 2019 were selected as the study objects. According to the method of random number table, the patients were divided into two groups:observation group（42 cases） and control group（40 cases）. All the patients were treated with respiratory failure and mechanical ventilation. The control group was treated with bronchoalveolar lavage with fiberoptic bronchoscope, and the observation group was treated with vibration expectoration before the treatment with fiberoptic bronchoscope. The clinical effects, Pa O₂/Fi O₂, WOB, and Cdyn of the two groups were observed before and 2 hours after treatment. The mechanical ventilation time, ICU time, and 28-day mortality of the two groups were compared between the two groups. Results After treatment, the PaO₂/FiO₂ and Cdyn levels in the observation group were 382.47±60.42,（38.43±4.50） mL/cmH₂ O, significantly higher than 351.37±44.31,（31.82±8.64） mL/cmH₂ O in the control group, and the WOB level in the observation group was（0.67±0.24） J/L, significantly lower than（0.95±0.36） J/L in the control group（P<0.05）. Mechanical ventilation time and ICU stay time in the observation group were（6.07±1.12） d and（7.96±2.38） d, which were significantly lower than（8.46±2.25） d and（11.85±3.67） d of the control group（P<0.05）. The 28-day hospital mortality was 4.76% in the observation group compared with 7.50% in the control group, and there was no significant difference（P>0.05）. The total effective rate of the observation group was 88.10%, which was significantly higher than 72.50% of the control group（P<0.05）. Conclusion Mechanical vibration expectoration combined with fiberbronchoscope is more beneficial to the improvement of pulmonary oxygenation and respiratory function in patients with severe pneumonia. It can shorten the course of disease and improve the clinical effect.更多还原