纤维支气管镜对急诊重症肺炎合并呼吸衰竭患者呼吸功能及血清炎症因子水平的影响

目的:探讨纤维支气管镜对急诊重症肺炎合并呼吸衰竭患者呼吸功能及炎症反应的影响。方法:选择2013年9月-2015年9月在我院接受治疗的重症肺炎合并呼吸衰竭患者89例作为研究对象,根据治疗方法不同,将患者分为研究组(47例)与对照组(42例)。对照组患者采用常规抗感染治疗,研究组患者在对照组基础上采用纤维支气管镜肺泡灌洗治疗。观察并比较两组患者治疗前后的动态顺应性(Cdyn)、氧合指数(Pa O2/Fi O2)、呼吸做功(WOB)、血清炎症因子水平的变化情况。结果:治疗前,两组患者Cdyn,WOB,Pa O2/Fi O2,CD11b+中性粒细胞、STREM-1及HMGB-1水平比较,差异均无统计学意义(P0.05);治疗后,对照组患者Cdyn、Pa O2/Fi O2及WOB均较治疗前显著升高,差异具有统计学意义(P0.05);研究组患者Cdyn及Pa O2/Fi O2较治疗前显著升高,而WOB较治疗前显著降低,差异具有统计学意义(P0.05);研究组患者Cdyn及Pa O2/Fi O2高于对照组,而WOB低于对照组,差异具有统计学意义(P0.05);两组患者CD11b+中性粒细胞、STREM-1及HMGB-1水平均较治疗前显著降低,且研究组显著低于对照组,差异均具有统计学意义(P0.05)。结论:纤维支气管镜肺泡灌洗能够改善急诊重症肺炎合并呼吸衰竭患者的呼吸功能,缓解机体炎症反应,具有重要的临床意义。

Effect of Fiber Bronchoscopy on Respiratory Function and Inflammatory Factors in Patients with Severe Pneumonia and Respiratory Failure*

Objective:To investigate the effect of fiber bronchoscopy on respiratory function and inflammatory reactions of patients with severe pneumonia and respiratory failure.Methods:89 cases with severe pneumonia and respiratory failure who were treated in our hospital from September 2013 to September 2015 were selected and according to the different treatment methods, the patients were divided into the research group (47 cases) and the control group (42 cases). The patients in the control group were treated with regular anti-infection treatment, while the patients in the research group were treated with the fiber bronchoscopy and bronchoalveolar lavage besides of the conventional method. Then the Cdyn, PaO2/FiO2, WOB and the serum levels of inflammatory factors were observed and compared between the two groups before and after the treatment.Results:Before treatment, there was no statistically significant difference about the Cdyn, WOB, PaO2/FiO2, STREM-1, HMGB-1 and CD11b+ between the two groups (P>0.05); After treatment, the Cdyn, WOB and PaO2/FiO2 in the control group significantly increased (P<0.05); the Cdyn and PaO2/FiO2 in the research group were significantly higher than before treatment, and WOB was significantly lower than before treatment (P<0.05); the Cdyn and PaO2/FiO2 in the research group were significantly higher than those of the control group, and the WOB was significantly lower than that of the control group (P<0.05); the levels of STREM-1, HMGB-1 and CD11b+ in the two groups were significantly lower than before treatment, and the research group was significantly lower than that of the control group, and the differences were statistically significant (P<0.05).Conclusion:Fiber bronchoscopy can improve the respiratory function and the inflammatory reactions of patients with severe pneumonia and respiratory failure.