纤维支气管镜吸痰技术联合利奈唑胺对重症肺部感染患者痰培养转阴率和感染相关生物标志物的影响

Clinical effect of fiberoptic bronchoscope sputum suctioning combined with linezolid on sputum culture conversion rate and infection related biomarkers in severe pulmonary infection patients

摘要:

目的 探讨重症肺部感染（SPI）患者接受纤维支气管镜吸痰技术联合利奈唑胺治疗，对痰培养转阴率和感染相关生物标志物的影响。方法 选择2022年1月－2023年10月该院接诊的SPI患者104例，随机分为两组，各52例。观察组接受纤维支气管镜吸痰技术联合利奈唑胺治疗，对照组单用利奈唑胺治疗。观察两组患者痰培养转阴率和症状（发热、咳痰、咳嗽和肺部啰音）消失时间；记录治疗前后血气指标［动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、氧合指数（OI）和动脉血二氧化碳分压（PaCO₂）］、感染相关生物标志物［降钙素原（PCT）、外周血中性粒细胞与淋巴细胞比值（NLR）、白细胞介素-6（IL-6）、可溶性髓系细胞表达触发受体-1（sTREM-1）和可溶性尿激酶型纤溶酶原激活物受体（suPAR）］水平、临床肺部感染评分（CPIS），以及急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）和不良反应发生情况。结果 观察组总有效率和痰培养转阴率分别为90.38%（47/52）和86.54%（45/52），明显高于对照组的75.00%（39/52）和65.38%（34/52），差异均有统计学意义（P < 0.05）。观察组症状（发热、咳痰、咳嗽和肺部啰音）消失时间明显短于对照组，差异均有统计学意义（P < 0.05）。治疗后，两组患者PaO₂、SaO₂和OI较治疗前明显升高（P < 0.05），且观察组明显高于同期对照组，PaCO₂、外周血NLR、血清PCT、IL-6、sTREM-1、suPAR水平、CPIS和APACHE Ⅱ评分较治疗前明显降低，且观察组低于对照组，差异均有统计学意义（P < 0.05）。观察组不良反应率为15.38%（8/52），与对照组的17.31%（9/52）比较，差异无统计学意义（P > 0.05）。结论 SPI患者接受纤维支气管镜吸痰技术联合利奈唑胺治疗，能有效地下调体内感染相关生物标志物水平，提高痰培养转阴率和临床疗效。

Abstract:

Objective To explore the effect of fiberoptic bronchoscope sputum suctioning combined with linezolid on sputum culture conversion rate and infection related biomarkers in patients with severe pulmonary infection (SPI).Methods The subjects of this study, 104 patients from January 2022 to October 2023, were randomly divided into two groups, each with 52 cases. The observation group was treated with fiberoptic bronchoscope sputum suctioning combined with linezolid, while the control group was administrated with merely linezolid. The sputum culture negative conversion rate, disappearance time of symptoms (fever, expectoration, cough and lung rale), blood gas indicators [oxygen saturation in arterial blood (SaO₂), partial pressure of oxygen in arterial blood (PaO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂), and oxygenation index (OI)] before and after treatment, levels of infection related biomarkers [procalcitonin (PCT), peripheral blood neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and soluble urokinase type plasminogen activator receptor (suPAR)], clinical pulmonary infection score (CPIS), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) before and after treatment, and the adverse reactions were recorded in two groups.Results The total effective rate and sputum culture clearance rate of the observation group were 90.38% (47/52) and 86.54% (45/52) respectively, significant higher than those of the control group [75.00% (39/52) and 65.38% (34/52)], the differences were statistically significant (P < 0.05). The disappearance time of symptoms (fever, expectoration, cough and lung rale) in observation group was significant shorter than that in control group, the difference was statically significant (P < 0.05). After treatment, PaO₂, SaO₂, and OI in two groups were significant higher than those before treatment, and the observation group was significantly higher than the control group, the PaCO₂, peripheral blood NLR, serum PCT, IL-6, sTREM-1, suPAR levels, CPIS and APACHE Ⅱ scores were lower than those before treatment, and observation group was lower than control group, the differences were statistically significant (P < 0.05). The incidence of adverse reaction was 15.38% (8/52) in observation group and 17.31% (9/52) in control group, the difference was not statistically significant (P > 0.05).Conclusion In treating SPI patients, the combination of fiberoptic bronchoscope sputum suctioning and linezolid can effectively downregulate the levels of infection related biomarkers in patients, improve the sputum culture clearance rate and clinical efficacy.