纤维支气管镜肺泡灌洗术对老年COPD患者合并重症肺部感染血氧指标及预后的影响
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摘要
目的探讨纤维支气管镜肺泡灌洗术对老年慢性阻塞性肺疾病(COPD)合并重症肺部感染患者的临床治疗效果和对血氧指标及预后的影响。方法选择2014年1月-2017年6月医院收治的老年COPD合并重症肺炎患者126例为研究对象,随机分为试验组和对照组,各63例。所有患者均给予常规对症治疗,试验组在此基础上进行纤维支气管镜肺泡灌洗术。对两组患者临床症状消失时间、疗程及对血氧指标[氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(SpO2)、酸碱度(pH)]及预后的影响进行分析,并评价临床疗效。结果试验组咳嗽消失时间、咳痰消失时间、肺部啰音消失时间、抗菌药物使用时间和住院时间分别为(12.71±2.16)、(8.81±2.76)、(5.73±1.25)、(8.54±3.12)和(15.38±3.29)天均短于对照组(P<0.05)。治疗后两组患者PaO2、SpO2均升高,而PaCO2下降,试验组以上指标为(64.28±5.59)mmHg、(95.53±4.35)mmHg、(33.56±5.52)%与对照组比较,差异有统计学意义(P<0.001);两组患者pH差异无统计学意义(P=0.058)。试验组疗效优于对照组(P=0.018)。试验组不良反应和死亡为7.94%(5/63)和4.80%(3/63)与对照组比较差异无统计学意义。试验组真菌定植率为7.94%(5/63)低于对照组20.63%(13/63)(P=0.042)。结论纤维支气管镜肺泡灌洗术治疗老年COPD合并重症肺部感染效果较好,能改善血氧指标和患者预后,具有一定的临床价值。
OBJECTIVE To investigate the clinical effect of bronchoscopic alveolar lavage on elderly patients with chronic obstructive pulmonary disease(COPD)complicated with severe pulmonary infection and its influence on blood oxygenation index and prognosis.METHODS A total of 126 elderly patients with COPD and severe pneumonia admitted to the hospital from Jan.2014 to Jun.2017 were enrolled in the study.They were randomly divided into the experimental group and the control group,with 63 cases in each group.All patients were given conventional symptomatic treatment,and the experimental group also received bronchoscopic alveolar lavage.The time when clinical symptoms disappeared,the course of treatment and the effects on blood oxygenation indexes(PaO2,PaCO2,SpO2,pH)and prognosis of the two groups were compared and analyzed,and the clinical efficacy was evaluated.RESULTS The time of disappearance of cough,the time of disappearance of cough,the time of disappearance of lung voice,the time of use of antibiotics and the length of hospital stay in the experimental group were(12.71±2.16),(8.81±2.76),(5.73±1.20),(8.54±3.12)and(15.38±3.29),respectively,significantly shorter than those of the control group(P<0.05).After treatment,PaO2 and SpO2 increased in both groups,while PaCO2 decreased.The above indexes in the experimental group were(64.28±5.59)mmHg,(33.56±5.52)%,(95.53±4.35)mmHg,and the difference was significant(P <0.001).The difference in pH between the two groups was significant(P=0.018).The efficacy of the experimental group was significantly better than that of the control group(P<0.05).The incidences of adverse reactions and death in the experimental group were 7.94%(5/63)and 4.80%(3/63),and there was no significant difference from those of the control group.The colonization rate of fungi in the experimental group was 7.94%(5/63),which was significantly lower than that in the control group(20.63%(13/63))(P=0.042).CONCLUSIONBronchoscopic alveolar lavage is a safe and effective treatment for elderly patients with COPD and severe pulmonary infection.It can significantly improve blood oxygenation index and patient prognosis and has certain clinical value.
OBJECTIVE To investigate the clinical effect of bronchoscopic alveolar lavage on elderly patients with chronic obstructive pulmonary disease(COPD)complicated with severe pulmonary infection and its influence on blood oxygenation index and prognosis.METHODS A total of 126 elderly patients with COPD and severe pneumonia admitted to the hospital from Jan.2014 to Jun.2017 were enrolled in the study.They were randomly divided into the experimental group and the control group,with 63 cases in each group.All patients were given conventional symptomatic treatment,and the experimental group also received bronchoscopic alveolar lavage.The time when clinical symptoms disappeared,the course of treatment and the effects on blood oxygenation indexes(PaO2,PaCO2,SpO2,pH)and prognosis of the two groups were compared and analyzed,and the clinical efficacy was evaluated.RESULTS The time of disappearance of cough,the time of disappearance of cough,the time of disappearance of lung voice,the time of use of antibiotics and the length of hospital stay in the experimental group were(12.71±2.16),(8.81±2.76),(5.73±1.20),(8.54±3.12)and(15.38±3.29),respectively,significantly shorter than those of the control group(P<0.05).After treatment,PaO2 and SpO2 increased in both groups,while PaCO2 decreased.The above indexes in the experimental group were(64.28±5.59)mmHg,(33.56±5.52)%,(95.53±4.35)mmHg,and the difference was significant(P <0.001).The difference in pH between the two groups was significant(P=0.018).The efficacy of the experimental group was significantly better than that of the control group(P<0.05).The incidences of adverse reactions and death in the experimental group were 7.94%(5/63)and 4.80%(3/63),and there was no significant difference from those of the control group.The colonization rate of fungi in the experimental group was 7.94%(5/63),which was significantly lower than that in the control group(20.63%(13/63))(P=0.042).CONCLUSIONBronchoscopic alveolar lavage is a safe and effective treatment for elderly patients with COPD and severe pulmonary infection.It can significantly improve blood oxygenation index and patient prognosis and has certain clinical value.
引文
[1]孙延娟,杨宗强,孙延龙,等.肺复张治疗对重症肺部感染患者血流动力学及氧合水平的影响分析[J].中华医院感染学杂志,2017,27(22):5079-5082.
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[12] Klooster K,ten Hacken NH,Hartman JE,et al.Bronchoscopic interventions in severe COPD:improvement of pulmonary function,exercise capacity and quality of life[J].Ned Tijdschr Geneeskd,2015,159:A8497.
[13] Murphy TF,Brauer AL,Pettigrew MM,et al.Persistence of moraxella catarrhalis in chronic obstructive pulmonary disease and regulation of the Hag/MID adhesin[J].J Infect Dis,2018,28.
[14]Mizumori Y,Mochiduki Y,Nakahara Y,et al.Effects of bronchoscopic lung volume reduction using transbronchial infusion of autologous blood and thrombin in patients with severe chronic obstructive pulmonary disease[J].J Thorac Dis,2015,7(3):413-421.
[15] Abdallah SJ,Smith BM,Wilkinson-Maitland C,et al.Effect of abdominal binding on diaphragmatic neuromuscular efficiency,exertional breathlessness,and exercise endurance in chronic obstructive pulmonary disease[J].Front Physiol,2018,14(9):1618.
[16]占明.纤维支气管镜联合肺泡灌洗术治疗呼吸机相关性肺炎患者的临床疗效分析[J].中华肺部疾病杂志(电子版),2014,7(4):8-11.
[17]唐先锋,李党育,龙成凤.纤支镜灌洗治疗60例重症肺部感染的临床分析[J].现代预防医学,2012,39(1):212-213.
[2] Hirano R,Fujita M,Matsumoto T,et al.Inhaled corticosteroids might not increase the risk of pneumonia in patients with chronic obstructive pulmonary disease in Japan[J].Int J Chron Obstruct Pulmon Dis,2018,23(13):3503-3509.
[3] Deng XJ,Yang LP.Effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the SIRS and target organ damage in patients with severe pneumonia complicated by respiratory failure[J].J Hainan Med University,2017,23(14):9-12.
[4] Hoffmann C,Hanisch M,Heinsohn JB,et al.Increased vulnerability of COPD patient groups to urban climate in view of global warming[J].Int J Chron Obstruct Pulmon Dis,2018,23(13):3493-3501.
[5]杨兆辉,段瑞祥,杨晶,等.纤维支气管镜与肺泡灌洗术治疗老年重症肺部感染患者的疗效分析[J].中华医院感染学杂志,2016,26(6):1300-1302.
[6]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华内科杂志,2007,46(1):8-17.
[7]李熙鸿.儿童重症肺炎诊断标准的优缺点[J].中华实用儿科临床杂志,2017,32(6):408-411.
[8]鲁平海,李晓作.COPD合并肺部感染患者接受盐酸氨溴索支气管肺泡灌洗后全身炎症及应激反应的评估[J].海南医学院学报,2017,23(21):2937-2940.
[9]高明明,张英延,王顺莹.COPD患者合并肺部真菌感染的高危因素分析及预防[J].临床肺科杂志,2014,(8):1424-1426.
[10]尹琴,张继先,夏玲,等.COPD患者合并肺部鲍曼不动杆菌感染临床特点及耐药分析[J].实用医学杂志,2014,(20):3368-3369.
[11] Kopsaftis ZA,Sulaiman NS,Mountain OD,et al.Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting:systematic review[J].Syst Rev,2018,29,7(1):213.
[12] Klooster K,ten Hacken NH,Hartman JE,et al.Bronchoscopic interventions in severe COPD:improvement of pulmonary function,exercise capacity and quality of life[J].Ned Tijdschr Geneeskd,2015,159:A8497.
[13] Murphy TF,Brauer AL,Pettigrew MM,et al.Persistence of moraxella catarrhalis in chronic obstructive pulmonary disease and regulation of the Hag/MID adhesin[J].J Infect Dis,2018,28.
[14]Mizumori Y,Mochiduki Y,Nakahara Y,et al.Effects of bronchoscopic lung volume reduction using transbronchial infusion of autologous blood and thrombin in patients with severe chronic obstructive pulmonary disease[J].J Thorac Dis,2015,7(3):413-421.
[15] Abdallah SJ,Smith BM,Wilkinson-Maitland C,et al.Effect of abdominal binding on diaphragmatic neuromuscular efficiency,exertional breathlessness,and exercise endurance in chronic obstructive pulmonary disease[J].Front Physiol,2018,14(9):1618.
[16]占明.纤维支气管镜联合肺泡灌洗术治疗呼吸机相关性肺炎患者的临床疗效分析[J].中华肺部疾病杂志(电子版),2014,7(4):8-11.
[17]唐先锋,李党育,龙成凤.纤支镜灌洗治疗60例重症肺部感染的临床分析[J].现代预防医学,2012,39(1):212-213.