振动排痰联合纤维支气管镜肺灌洗治疗重症肺炎机械通气患者的临床研究*

Efficacy of vibration sputum elimination combining bronchoalveolar lavage in treating mechanically ventilated patients with severe pneumonia*

摘要:

目的??探讨纤维支气管镜肺泡灌洗联合振动排痰治疗重症肺炎机械通气患者的安全性及治疗效果。方法?将2014年1月-2015年8月湖南省人民医院重症监护室（ICU）收治的166例重症肺炎机械通气患者纳入研究，按其入ICU时间顺序随机分为观察组和对照组，观察组83例采用纤维支气管镜肺灌洗前联合振动排痰治疗，对照组83例采用纤维支气管镜肺灌洗治疗，两组均接受常规治疗。比较两组患者生命体征变化指标、呼吸功能指标、疗效及预后指标。结果?①生命体征：两组患者治疗前10 min、治疗中10 min、治疗后30 min呼吸频率、心率、平均动脉压比较差异无统计学意义（P >0.05）；②呼吸功能：观察组氧合指数（PaO2/FiO2）、动态顺应性（Cydn）水平高于对照组、呼吸做功（WOB）水平低于于对照组（P ≤0.05）；③疗效及预后指标：观察组治疗有效率高于对照组、机械通气时间及ICU监护时间均短于对照组（P ≤0.05）；两组死亡率差异无统计学意义（P >0.05）。结论?纤维支气管镜肺灌洗联合震动排痰比单纯纤维支气管镜肺灌洗更安全有效，有助于改善呼吸功能、缩短机械通气时间及ICU监护时间。

Abstract:

Objective?To investigate the safety and effectiveness of fiber bronchoscopy lavage combined with vibration sputum expectoration in patients with severe pneumonia having mechanically ventilation. Methods 166 cases from January 2014 ～ August 2015 in ICU of Hunan Provincial People’s Hospital were randomly divided the patients into observation group and control group according to the admitted time, 83 cases in each group. The observation group used vibration sputum excretion support before the lung lavage therapy, while control group used bronchoscopy lung lavage treatment only. Both groups were treated with conventional therapy. Changes in vital signs, respiratory function parameters, efficacy and prognostic factors between the two groups were observed and compared. Results Vital signs: 10 minutes before and after the treatment , 30 minutes after treatment, there was no statistically significant difference between the two groups (P >0.05); respiratory function: oxygenation index, dynamic compliance level were higher and work of breathing was lower in observation group compared with control group (P ≤0.05); the efficacy and prognostic indexes: the observation group had higher treatment efficiency and its duration of mechanical ventilation and ICU monitoring time were shorter than the control group (P ≤0.05); the mortality in two groups had no statistically significant difference (P >0.05). Conclusion Bronchoscopy lung lavage combined with vibration sputum excretion was safer and more effective, which improved respiratory function, shortened duration of mechanical ventilation and ICU monitoring time.