摘要
目的;探讨应用纤维支气管镜(bronchofibroscope,BFS)行支气管肺泡灌洗(bronchoalveolar Lavage,BAL)治疗呼吸机相关性肺炎(ventilatorassociated pneumonia,VAP)对患者呼吸力学和预后的影响。方法:应用BFS对综合ICU内92例VAP患者行BAL治疗。监测患者生命体征、动脉血气分析、呼吸力学指标,对灌洗前后各项监测指标及临床情况进行对比分析。于灌洗前、灌洗后第48h、7d拍摄床旁X线胸片,计算X线胸片改善率。记录确诊VAP后MV时间和统计脱机成功率、死亡率。结果:88.04%(81/92)患者灌洗完毕后双肺痰鸣音立即消失,临床上患者气短喘息等症状得到明显缓解:55.43%(51/92)体温逐渐下降,78.26%(72/92)术后24h至48h外周血白细胞下降至正常;48h后X线胸片病灶吸收率57.60%(53/92)。PaO2/FiO2于灌洗后1 h就开始改善,并持续升高;同时在灌洗后1h患者气道峰压(PIP)、呼吸功(WOBvent)和吸气阻力(RAW)开始持续降低,肺动态顺应性(Cdyn)开始持续增加(P<0.05)。灌洗后4h患者PIP、WOBven和RAW较灌洗后1h有显著性差异(P<0.05)。7d后X线胸片改善率94.57%(87/92);60.87%(56/92)患者能在5d至7d内脱机;最终成功脱机率85.87%(79/92);死亡率14.13%(13/92)。结论:对VAP进行BFS行床旁BAL治疗,能有效改善患者呼吸症状,提高机体通气换气功能,提高感染控制效能,缩短VAP脱机时间,降低死亡率,为综合治疗VAP提供了一条有效新途径。
Objective： To investigate the effects of respiratory mechanics and prognostic in patients with ventilator asseciated pneumonia（VAP） who were treated by bronchoalvenlar Lavage （BAL） with brenchofibroscope（BFS） .Methods： 92 cases with VAP in synthetic intensive care unit （ICU） were treated by BAL with BFS. Monitoring the biotic physical sign, the results of arterial blood gas analysis, the index of respiratory mechanics and clinical setting, then analyzing these indexes between them which before BAL and them which after BAL. Shot X- ray sternum at bedside before BAL and 48h, 7d which times were after BAL, then calculated the improvement rates of them. Recorded the time of MV after VAP were final diagnosis, and added up achievement ratio of off- line and death rate. Results： wheezy phlegm of 88.04% （81/92） patients disappeared immediately after BAL, and clinical symptoms such as short breath, gasp relieved obviously. Temperature of 55.43 % （51/92） patients fell - off, WBC of 78.26 % （72/92） patients decreased to the normal level after 24- 48h with BAL. The absorptivity of foons of infection which was displayod in X - ray stemum was 57.60% （53/92） after 48h with BAL. PaO2/FiO2 began to improve after 1h with BAL and advanced continually. Meanwhile PIP, WOBvent and RAW began to degrade continually, and Cdyn improved （ P 〈 0.05 ）. PIP, WOBvent and RAW which were recorded after 4h with BAL were lower than them which were recorded after 1 h with BAL（P 〈 0.05）After 7d the improvement rate of X- ray sternum was 94.57% （87/92） ,60.87% （56/92） patients could be off- line within 5 - 7d. The rate of Final off - line was 85.87% （79/92）, the death rate was 14.13% （13/92）. Conclusion： The therapy of BAL with BFS at bedside could improve the breathing symptom of VAP. The BAL did good to increase the function of venting and gas exchange, develop the efficacy of infection control, to shorten the off- line time of VAP and to decrease the death rate on the patients with VAP. Thus it was a new and effective way to combined therapy of VAP.
出处
《激光杂志》
CAS
CSCD
北大核心
2009年第3期86-87,共2页
Laser Journal
基金
重庆市卫生局(2008-2-89)资助项目
关键词
纤维支气管镜
支气管肺泡灌洗
重症监护病房
呼吸力学
预后
bronchofibroscope
bronchoalveolar Lavage
intensive care unit
respinatory mechanics
prognosis
