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目的研究纤维支气管镜肺泡灌洗联合抗感染治疗重症呼吸机相关性肺炎(VAP)的临床疗效。方法随机双盲法将符合纳入标准的68例重症呼吸机相关性肺炎患者分为两组,每组34例,对照组采取抗感染联合常规灌洗吸痰治疗,观察组则行纤维支气管镜肺泡灌洗联合抗感染治疗,比较两组临床疗效、治疗前后呼吸力学参数、CPIS评分及机械通气时间等相关指标。结果观察组总有效率94.1%,显著高于对照组的76.5%(P<0.05);观察组灌洗后1 h、4 h气道峰压(PIP)、呼吸功(WOB)、气道阻力(AWR)、动态顺应性(Cdyn)水平明显优于对照组(P<0.05);两组机械通气时间[(9.7±5.3)VS(12.6±6.2)]d、ICU入住时间[(11.6±6.0)VS(14.9±7.4)]d、治疗第7d CPIS评分[(14.0±2.5)VS(17.2±2.6)]分比较差异均有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗联合抗感染治疗重症VAP疗效明确,能明显改善患者呼吸力学参数及肺部感染症状,缩短机械通气时间,值得临床推广。
Objective To study the clinical effects of bronchoflagoral bronchoalveolar lavage combined with anti-infection in the treatment of severe ventilator-associated pneumonia (VAP). Methods A total of 68 patients with severe ventilator-associated pneumonia who met the inclusion criteria were randomly divided into two groups (34 in each group). The patients in the control group were treated with anti-infective combined with routine lavage and suctioning. The observation group received bronchoscopy alveolus Lavage combined with anti-infective treatment, the clinical efficacy of two groups were compared, before and after treatment of respiratory mechanics parameters, CPIS score and mechanical ventilation time and other related indicators. Results The total effective rate in observation group was 94.1%, significantly higher than 76.5% in control group (P <0.05). The peak airway pressure (PIP), respiratory work (WOB), airway resistance (AWR) and dynamic compliance (Cdyn) were significantly higher than those of the control group (P <0.05). The duration of mechanical ventilation (9.7 ± 5.3 vs 12.6 ± 6.2) d and ICU stay [(11.6 ± 6.0) ) VS (14.9 ± 7.4) d, the CPIS score at the 7th day after treatment [(14.0 ± 2.5) vs (17.2 ± 2.6)] was statistically significant difference (P <0.05). Conclusion Bronchoscopical bronchoalveolar lavage combined with anti-infection treatment of severe VAP clear effect, can significantly improve the patient’s respiratory mechanics parameters and pulmonary infection symptoms, shorten the time of mechanical ventilation, is worthy of clinical promotion.