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

摘要

目的:观察纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎(VAP)患者血清降钙素原(PCT)和C反应蛋白(CRP)的影响.方法:回顾性选取在医院住院治疗的70例重症VAP患者,根据数表法随机将其分为观察组和对照组,每组35例.观察组采用纤维支气管镜肺泡灌洗治疗,对照组采用常规肺泡灌洗+吸痰治疗;比较两组肺部感染控制时间、机械通气治疗时间、退热时间、白细胞计数及临床肺部感染评分(CPIS),并对两组治疗前后的呼吸功能指标、血气指标、血清CRP和PCT表达水平变化进行比较.结果:观察组肺部感染控制时间、机械通气治疗时间及退热时间均短于对照组,两组比较差异有统计学意义(t=12.954,t=13.124,t=11.062;P<0.05);白细胞计数及CPIS评分均小于对照组,两组比较差异有统计学意义(t=11.804,t=11.342;P<0.05);两组治疗后患者动态肺顺应性(DLC)、气道阻力(Raw)、峰值吸气压力(PIP)和呼吸做功(WOB)呼吸功能指标以及3项血气指标均明显得到改善,且观察组较对照组改善更为显著,两组比较差异有统计学意义(t=9.324,t=8.653,t=10.122,t=8.154;t=9.530,t=9.691,t=10.012;P<0.05);两组治疗后血清CRP、PCT表达水平均明显降低,且观察组较对照组降低更为显著,两组比较差异有统计学意义(t=15.358,t=13.157;P<0.05).结论:纤维支气管镜肺泡灌洗可明显改善重症VAP患者呼吸功能指标、血气指标,降低血清CRP和PCT表达水平,疗效显著.%Objective:To observe the effect of bronchoalveolar lavaging of fiberoptic bronchoscopy for the serum procalcitonin (PCT) and C-reactive protein (CRP) of patients with severe ventilator-associated pneumonia (VAP). Methods: 70 patients with severe VAP were enrolled in the retrospective study and were divided into observation group (35 cases) and control group (35 cases). Patients of observation group received the treatment of bronchoalveolar lavaging of fiberoptic bronchoscopy, and patients of control group received the treatment of routine bronchoalveolar lavaging combined with suctioning. The control time of pulmonary infection, therapy time of mechanical ventilation, time of bringing down fever, white blood cell count and clinical pulmonary infection score (CPIS) of the two groups were compared and analyzed. Besides, the changes of respiratory functional indicator, blood and respiration indicator, the expression of serum CRP and PCT of the two groups at pre-and post treatment were compared.Results:The control time of pulmonary infection, therapy time of mechanical ventilation and time of bringing down fever of observation group were significantly shorter than that of control group (t=12.954,t=13.124,t=11.062,P<0.05). And both of the white blood cell count and CPIS of observation group were significantly lower than that of control group (t=11.804,t=11.342,P<0.05). Besides, all of these indicators including DLC, Raw, PIP, WOB, PaO2, PaO2/FiO2 and PaCO2 of two groups were obviously improved while these results of observation group were significantly better than that of control group (t=9.324, 8.653, t=10.122,t=8.154,t=9.530,t=9.691,t=10.012,P<0.05). And both of the expression of CRP and PCT of the two groups were obviously reduced, and the results of observation group were significantly better than that of control group (t=15.358, t=13.157,P<0.05).Conclusion: Bronchoalveolar lavaging of fiberoptic bronchoscopy can significantly improve the respiratory function index, blood and respiration indicator and can reduce the expression level of serum CRP and PCT for patients with VAP, and its curative effect is remarkable.