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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(P>0.05);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(P<0.05);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(P<0.05);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(P<0.05);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(P<0.05)。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。
Objective: To investigate the effects of bronchofibroscopy on respiratory function and inflammatory response in patients with severe pneumonia complicated with respiratory failure. Methods: A total of 89 patients with severe pneumonia complicated with respiratory failure who were treated in our hospital from September 2013 to September 2015 were selected as study subjects. According to the different treatment methods, the patients were divided into study group (47 cases) and control group (42 cases) example). Patients in the control group were treated with conventional anti-infective therapy. Patients in the study group were treated with bronchoalveolar lavage on the basis of the control group. The changes of dynamic compliance (Cdyn), oxygenation index (Pa O2 / Fi O2), respiratory effort (WOB) and serum levels of inflammatory cytokines in both groups before and after treatment were observed and compared. Results: There was no significant difference in the levels of Cdyn, WOB, PaO2 / Fi O2, CD11b + neutrophils, STREM-1 and HMGB-1 between the two groups before treatment (P> 0.05) The levels of Cdyn, Pa O2 / Fi O2 and WOB in group A were significantly higher than those before treatment (P <0.05), and the levels of Cdyn and Pa O2 / Fi O2 in study group were significantly higher than those before treatment The levels of Cdyn and Pa O2 / Fi O2 in the study group were significantly higher than those in the control group, while the WOB was lower than that in the control group (P <0.05). The difference was statistically significant (P <0.05) The levels of CD11b + neutrophils, STREM-1 and HMGB-1 in the patients group were significantly lower than those before treatment, and the levels in the study group were significantly lower than those in the control group (P <0.05). Conclusion: Bronchoscopical bronchoalveolar lavage can improve the respiratory function and relieve the inflammatory reaction in patients with severe pneumonia complicated with respiratory failure. It has important clinical significance.