便携式纤支镜肺泡灌洗对老年肺部感染呼吸衰竭有创机械通气患者降钙素原和超敏C反应蛋白的影响及治疗价值

Clinical value and impact to PCT and hs-CRP of portable fiberbronchoscope alveolar lavage to invasive mechanical ventilation in the respiratory failure of pulmonary infection in the elderly patients

摘要:

目的  探讨便携式纤支镜肺泡灌洗对老年肺部感染呼吸衰竭有创机械通气患者血清降钙素原（PCT）和超敏C反应蛋白（hs-CRP）的影响及治疗价值。方法  80例老年肺部感染合并呼吸衰竭有创机械通气治疗的患者，予以抗感染、扩张气道、祛痰和营养支持等治疗，对照组40例予以常规吸痰管吸痰治疗，观察组40例加用便携式纤支镜经气管导管吸痰和支气管肺泡灌洗、两天1次。治疗前及治疗1周后检测患者的血清PCT、hs-CRP、白细胞（WBC）、中性粒细胞比例（N）、动脉氧分压（PaO2）、动脉血二氧化碳分压（PaCO2），比较两组治疗前后各指标的变化；观察并比较两组患者有创通气时间、住院时间、病死率和并发症。结果  治疗1周后PCT、hs-CRP、WBC、N、PaO2和PaCO2与治疗前比较两组均有明显改善（P <0.05），观察组治疗后各指标改善明显优于对照组（P <0.05）；有创通气时间、住院时间和病死率比较，观察组明显低于对照组（P <0.05）。两组并发症比较差异无统计学意义（P >0.05）。结论  便携式纤支镜肺泡灌洗可使老年肺部感染呼吸衰竭有创机械通气患者的血清PCT和hs-CRP明显下降，治疗安全有效，具有重要的临床应用价值。

Abstract:

 Abstract: Objective To investigate the clinical value and impact to PCT and hs-CRP of portable fiberbronchoscope alveolar lavage to elderly pulmonary infection respiratory failure in the treatment of mechanical ventilation. Methods 80 cases of pulmonary infection in the elderly patients with respiratory failure received invasive mechanical ventilation and anti-infection, expansion airway, expectorant, nutritional support treatment. The control group of 40 cases treated with conventional sputum suction tube suction phlegm. The observation group (bronchofiberscope group) of 40 patients added the use of portable fibrobronchoscope aspiration of sputum and alveolar lavage through tracheal intubation catheter, once every two days. Tested serum procalcitonin (PCT), high sensitive C reactive protein (hs-CRP), white blood cell (WBC), percentage of neutrophils (N), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) of two groups patients before the treatment and 1 week after the treatment. Change of each index were compared between the two groups before and after treatment. Invasive ventilation time, length of hospital stay, mortality and complications of the two groups were observed and compared. Results After 1 week treatment, PCT, hs-CRP, WBC, N, PaO2, PaCO2 compared with before treatment in two groups were significantly improved (P < 0.05). The indicators of observation group after treatment improved significantly better than the control group (P < 0.05). The invasive ventilation time, length of hospital stay, fatality rate in observation group was significantly lower than the control group (P < 0.05). Complications were no significance between two groups (P > 0.05). Conclusion Portable fiberbronchoscope alveolar lavage in respiratory failure of pulmonary infection in the elderly significantly decreased serum PCT and hs-CRP. This treatment is safe and effective in the treatment of invasive mechanical ventilation, and has important clinical application value.