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目的:探讨经支气管镜吸痰、灌洗和注药治疗难治性肺炎的临床疗效和安全性。方法:96例确诊的难治性肺炎患者被随机分为观察组和对照组,每组均为48例。对照组采用针对性和经验性常规治疗;观察组在常规治疗基础上行经支气管镜局部吸痰、灌洗和注药。比较两组治疗情况、通气功能和血气指标变化、疗效及不良反应情况等。结果:观察组住院时间和病灶好转时间仅为(12.45±3.25)d和(19.32±3.86)d均显著低于对照组住院和病灶好转时间(P<0.05),而住院费用仅为(30721.00±1004.00)元,显著少于对照组(P<0.05);治疗后体温、CRP、WBC、RR和HR水平分别下降到(36.74±0.40)℃、(34.9±3.0)mg/L、(9.49±1.20)×109/L、(21±5)次/min和(84±8)次/min,显著低于治疗前和对照组治疗后水平(P<0.05);总有效率为83.33%显著高于对照组52.08%(P<0.05),细菌培养阳性率85.42%,显著高于细菌培养阳性率29.17%(P<0.05);术后无严重并发症。结论:在常规治疗基础上经纤维支气管镜局部吸痰、灌洗和注药治疗难治性肺炎,能改善患者肺通气功能,提高临床治疗效果,缩短病程。
Objective: To investigate the clinical efficacy and safety of bronchoscopic suctioning, lavage and injection in the treatment of refractory pneumonia. Methods: Ninety-six patients with refractory pneumonia were randomly divided into observation group and control group, with 48 cases in each group. The control group used targeted and empirical routine treatment; observation group on the basis of conventional treatment bronchoscopy local suctioning, lavage and injection. Compare the two groups of treatment, ventilation and blood gas changes, efficacy and adverse reactions. Results: The hospitalization time and the improvement time of the lesion in the observation group were only (12.45 ± 3.25) d and (19.32 ± 3.86) d, respectively, which were significantly lower than those in the control group and the improvement time of the lesion (P <0.05) (P <0.05). The body temperature, CRP, WBC, RR and HR decreased to (36.74 ± 0.40) ℃, (34.9 ± 3.0) mg / L, (9.49 ± 1.20) ) × 109 / L, (21 ± 5) times / min and (84 ± 8) times / min, respectively, which were significantly lower than those before treatment and those in the control group (P <0.05). The total effective rate was 83.33% The positive rate of bacterial culture was 85.42%, which was significantly higher than that of bacterial culture (29.17%, P <0.05). There was no serious complication after operation. CONCLUSION: Local suctioning, lavage and injection of refractory pneumonia through bronchoscopy can improve pulmonary ventilation, improve clinical curative effect and shorten the course of disease on the basis of conventional treatment.