床旁支气管肺泡灌洗联合病原学检测在呼吸机相关性肺炎诊治中的应用效果观察
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摘要
目的探讨床旁支气管肺泡灌洗联合病原学检测在呼吸机相关性肺炎(VAP)诊断和治疗中的应用效果。方法选取2017年2月—2018年5月收治的VAP患者130例,按照治疗方法分为观察组和对照组,每组65例。2组均给予常规治疗,观察组给予床旁纤维支气管镜肺泡灌洗,对照组给予常规吸痰处理。对比2组临床疗效、肺部感染评分(CPIS)、呼吸动力学指标。结果观察组有效率均高于对照组(P <0. 05)。2组干预后CPIS和呼吸动力学指标均低于干预前,且观察组低于对照组(P <0. 05)。结论床旁支气管肺泡灌洗联合病原学检测临床效果更好,对患者肺部感染控制及呼吸动力学恢复疗效显著。
Objective To investigate effect of bedside bronchoalveolar lavage combined with etiological examination in diagnosis and treatment of patients with ventilator-associated pneumonia( VAP). Methods A total of 130 VAP patients admitted during February 2017 and May 2018 were divided into observation group and control group( n = 65 in each group) according to therapeutic methods. All patients had received conventional therapy. Observation group was given bronchoalveolar lavage through bedside fiberoptic bronchoscope,while control group was treated with conventional aspiration of sputum. Values of curative effect,clinical pulmonary infection score( CPIS) and pneodynamics indexes were compared between two groups. Results Value of effective rate in observation group was significantly higher than that in control group( P < 0. 05). After intervention,values of CPIS scores and pneodynamics indexes were significantly lower than those before intervention in two groups,and the values in observation group were significantly lower than those in control group( P < 0. 05). Conclusion Bedside bronchoalveolar lavage combined with etiological examination may achieve better therapeutic effect. It has significant effects on controlling pulmonary infection and recovery of respiratory dynamics.
Objective To investigate effect of bedside bronchoalveolar lavage combined with etiological examination in diagnosis and treatment of patients with ventilator-associated pneumonia( VAP). Methods A total of 130 VAP patients admitted during February 2017 and May 2018 were divided into observation group and control group( n = 65 in each group) according to therapeutic methods. All patients had received conventional therapy. Observation group was given bronchoalveolar lavage through bedside fiberoptic bronchoscope,while control group was treated with conventional aspiration of sputum. Values of curative effect,clinical pulmonary infection score( CPIS) and pneodynamics indexes were compared between two groups. Results Value of effective rate in observation group was significantly higher than that in control group( P < 0. 05). After intervention,values of CPIS scores and pneodynamics indexes were significantly lower than those before intervention in two groups,and the values in observation group were significantly lower than those in control group( P < 0. 05). Conclusion Bedside bronchoalveolar lavage combined with etiological examination may achieve better therapeutic effect. It has significant effects on controlling pulmonary infection and recovery of respiratory dynamics.
引文
[1]中华医学会呼吸病分会.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J].中华结核与呼吸杂志,2018,41(4):255-280.
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[12]张素花,朱进,李秀华.呼吸机相关性肺炎的病原学特点及对预后的影响[J].内科急危重症杂志,2016,22(3):190-193,198.
[13] Liao X L,Kang Y. Reappraisal of the role of procalcitonin and clinical pulmonary infection score in diagnosis and treatment of ventilator-associated pneumonia[J].Chin J Intem Med,2018,57(5):368-369.
[14]青措,张琼,张红,等.应用不同频次支气管肺泡灌洗治疗呼吸机相关性肺炎患者的疗效比较[J].实用临床医药杂志,2017,21(19):114-116.
[15]王昕,王强,陈秋红,等.纤维支气管镜下肺泡灌洗辅助治疗呼吸机相关性肺炎患者效果观察[J].疑难病杂志,2017,16(8):784-787.
[16]石泽亚,秦月兰,祝益民,等.纤维支气管镜肺泡灌洗联合振动排痰治疗重症肺炎机械通气患者的效果观察:一项286例患者前瞻性随机对照研究[J].中华危重病急救医学,2017,29(1):66-70.
[17]窦志芳,陈乾华.脑钠肽联合CPIS评分在老年重症肺炎患者早期评估中的价值[J].实用医学杂志,2016,32(11):1893-1894.
[18] Bullone M,Lavoie J. Science-in-brief:Equine asthma diagnosis:Beyond bronchoalveolar lavage cytology[J]. Equine Vet,2017,49(3):263-265.
[19] Drew D A,Nishihara R,Lochhead P,et al. A Prospective Study of Smoking and Risk of Synchronous Colorectal Cancers[J]. Am J Gastroenterol,2017,112(3):493-501.
[20]王小江,李承红.纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎患者血清降钙素原和C反应蛋白的影响[J].中国医学装备,2017,14(10):93-96.
[2]高晓东,胡必杰,崔扬文,等.中国大陆46所医院呼吸机相关性肺炎发病率多中心前瞻性监测[J].中国感染控制杂志,2015,14(8):540-543.
[3]许艳军,李茂琴,史载祥,等.肺泡灌洗联合抗感染治疗呼吸机相关肺炎的研究[J].热带医学杂志,2016,16(2):206-209.
[4]何元.纤维支气管镜吸痰联合氨溴索治疗呼吸机相关性肺炎的临床疗效[J].实用心脑肺血管病杂志,2016,24(6):104-107.
[5]李连生,李芃菲,陶素梅,等.痰热清注射液联合纤维支气管镜对呼吸机相关性肺炎患者呼吸力学、炎性因子及氧化应激的影响[J].现代中西医结合杂志,2017,26(29):3208-3211.
[6]丁磊,王振洲.降钙素原联合临床肺部感染评分在呼吸机相关性肺炎早期诊断中的应用[J].临床和实验医学杂志,2018,17(4):418-422.
[7]刘成产,刘如喜,周杰,等. ICU中呼吸机相关性肺炎的病原学及耐药性分析[J].中华全科医学,2016,14(8):1272-1274.
[8]赵文彩,张香丽,张玉莲.回授法在管道护理小组预防非计划拔管中的应用及其效果[J].护士进修杂志,2017,32(19):1798-1800.
[9]夏治,黄成姣,汤文,等. 54例PICU呼吸机相关性肺炎病原学分析及用药情况调查[J].实用临床医药杂志,2016,20(5):169-170.
[10]周欣.重症监护病房呼吸机相关性肺炎的病原学及耐药性分析[J].中国医学装备,2016,13(1):111-113.
[11]袁巧,白静静,袁喆,等. 2013—2015年重症监护病房的呼吸机相关性肺炎病原学构成及耐药性分析[J].现代检验医学杂志,2017,32(3):45-48.
[12]张素花,朱进,李秀华.呼吸机相关性肺炎的病原学特点及对预后的影响[J].内科急危重症杂志,2016,22(3):190-193,198.
[13] Liao X L,Kang Y. Reappraisal of the role of procalcitonin and clinical pulmonary infection score in diagnosis and treatment of ventilator-associated pneumonia[J].Chin J Intem Med,2018,57(5):368-369.
[14]青措,张琼,张红,等.应用不同频次支气管肺泡灌洗治疗呼吸机相关性肺炎患者的疗效比较[J].实用临床医药杂志,2017,21(19):114-116.
[15]王昕,王强,陈秋红,等.纤维支气管镜下肺泡灌洗辅助治疗呼吸机相关性肺炎患者效果观察[J].疑难病杂志,2017,16(8):784-787.
[16]石泽亚,秦月兰,祝益民,等.纤维支气管镜肺泡灌洗联合振动排痰治疗重症肺炎机械通气患者的效果观察:一项286例患者前瞻性随机对照研究[J].中华危重病急救医学,2017,29(1):66-70.
[17]窦志芳,陈乾华.脑钠肽联合CPIS评分在老年重症肺炎患者早期评估中的价值[J].实用医学杂志,2016,32(11):1893-1894.
[18] Bullone M,Lavoie J. Science-in-brief:Equine asthma diagnosis:Beyond bronchoalveolar lavage cytology[J]. Equine Vet,2017,49(3):263-265.
[19] Drew D A,Nishihara R,Lochhead P,et al. A Prospective Study of Smoking and Risk of Synchronous Colorectal Cancers[J]. Am J Gastroenterol,2017,112(3):493-501.
[20]王小江,李承红.纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎患者血清降钙素原和C反应蛋白的影响[J].中国医学装备,2017,14(10):93-96.