纤维支气管镜吸痰对全肺切除术后心衰治疗效果的观察

目的:探讨规律纤维支气管镜吸痰对全肺切除术后心衰的治疗效果。方法:选取唐都医院胸外科于2012年1月至2014年1月行开胸全肺切除术,且术后并发心衰的患者184例进行前瞻性随机对照研究,将所选患者分为研究组(96例)和对照组(88例),前者除常规心衰治疗外,每天至少1次使用纤维支气管镜吸痰,必要时可根据痰量增加吸痰次数;后者仅采用利尿、强心、扩血管等常规疗法,比较两组患者的心指数、呼吸频率、动脉血气分析等指标,同时测定和比较两组患者治疗后72 h的血浆脑钠肽浓度。结果:治疗后1 h,对照组患者的心指数由(2.7±0.2)L/min·m2升高至(3.1±0.3)L/min·m2,呼吸频率由(35.4±2.9)次/分降至(21.3±2.5)次/分,Pa O2由(57.4±3.9)mm Hg升至(60.3±3.4)mm Hg,Sa O2由(83.5±7.1)%升至(86.3±3.7)%;研究组患者的心指数由(2.8±0.1)L/min·m2升高至(3.5±0.2)L/min·m2,呼吸频率由(34.2±3.1)次/分降至(19.2±2.2)次/分,Pa O2由(56.5±4.8)mm Hg升至(66.2±7.1)mm Hg,Sa O2由(84.5±6.5)%升至(91.6±3.5)%,差异具有统计学意义(P0.05),研究组患者治疗后的以上指标水平均明显优于对照组(P0.05)。治疗后24 h内,79.2%的研究组患者咳嗽、咳痰及肺部湿罗音基本缓解,对照组患者以上症状、体征的缓解率为47.7%,差异具有统计学意义(P0.05)。治疗后72 h,研究组患者的血浆脑钠肽浓度显著低于对照组患者(576.3±77.6 vs894.6±86.5,P0.01)。结论:支气管镜吸痰有助于改善全肺切除术后心衰患者的心肺功能。

The Effects of SputumSuction Treatment by Fiberoptic Bronchoscopy on Patients with Heart Failure after Pneumonectomy

Objective:To explore the effects of sputum suction treatment by fiberoptic bronchoscopy on patients with heart failure after pneumonectomy.Methods:120 patients who had accepted pneumonectomy and underwent postoperative heart failure in Tangdu hospital from January 2012 to January 2014 were selected. All the patients were divided into study group and control group equally. The patients in study group accepted sputum suction treatment by fiberoptic bronchoscopy and classic therapy including diuretic, heart enhance and hemangiectasis therapy. Fiberopticbronchoscopy was used at least 1 times per day, the frequency could be increased if patients'' sputumwas too much. Patients in control group only received classic therapy. The heart index, respiratory rate, arterial blood gas analysis and serum brain natriuretic peptide level at 72h after treatment were measured and compared between two groups.Results:At 1h after treatment, the heart index of patients in control group increased from (2.7± 0.2) L/min·m2 to (3.1± 0.3) L/min·m2, the respiratory rate decreased from 35.4± 2.9 times per min to 21.3± 2.5 times per min, the PaO2 increased from 57.4± 3.9 mmHg to 60.3± 3.4 mmHg, the SaO2 increased from(83.5± 7.1)%to (86.3± 3.7)%, and the differences were statistically significant(P<0.05); while the heart index of patients in study group increased from(2.8± 0.1) L/min·m2 to (3.5± 0.2) L/min·m2, the respiratory rate decreased from34.2± 3.1 times per min to 19.2± 2.2 times per min, the PaO2 increased from 56.5± 4.8 mmHg to 66.2± 7.1 mmHg, the SaO2 increased from (84.5± 6.5)% to (91.6± 3.5)%, and the differences were statistically significant(P<0.05). Moreover, the levels of index mentioned above were all better in study group than those in the control group (P<0.05). The cough, expectoration and pulmonary moist rales significantly relieved in 79.2%of patients in study group within 24 h, while in control group, this percentage was 47.7%, which was obviously lower than that of the study group (P<0.05). The serumBNP level of study group was much lower than that of the control group (576.3± 77.6 vs 894.6± 86.5, P<0.01) at 72 h after treatment.Conclusion:Sputum suction treatment by fiberoptic bronchoscopy was an efficient therapy in patients with heart failure after pneumonectomy.