摘要
目的 探讨纤维支气管镜下吸痰和灌洗对重症肺炎患者的呼吸力学指标、氧化应激指标、基质金属蛋白酶-9/基质金属蛋白酶抑制剂-1(MMP-9/TIMP-1)的影响,观察其临床效果。方法 选取2019年8月—2023年4月于呼和浩特市第一医院的162例重症肺炎患者。患者经随机数字表法分为两组,均于入院后立即实施气管插管、机械通气及抗感染等基础治疗。对照组在此基础方案上,通过气管插管定期进行无菌吸痰操作。观察组在此基础治疗外,加用了纤维支气管镜下的吸痰和灌洗治疗。对比分析了两组间在临床总有效率、呼吸力学参数、氧化应激状态标志物、MMP-9/TIMP-1以及肺部湿啰音消失时间、退热时间上的差异。结果 治疗后,观察组临床总有效率(85.19%)高于对照组(70.37%)(χ^(2)=5.143,P<0.05);观察组患者RaW明显低于对照组(t=14.344,P<0.05),观察组患者Cst明显高于对照组(t=15.436,P<0.05)。观察组患者MDA明显低于对照组(t=14.200,P<0.05),观察组患者SOD(t=16.754,P<0.05)和TAC(t=6.872,P<0.05)明显高于对照组(P<0.05)。观察组患者血清MMP-9(t=9.433,P<0.05)和TIMP-1(t=16.353,P<0.05)明显低于对照组;观察组肺部湿啰音消失时间(t=4.680,P<0.05)和退热时间(t=3.740,P<0.05)均低于对照组。结论 纤维支气管镜下吸痰和灌洗操作应用于重症肺炎,可有效提高临床疗效,改善呼吸力学指标,减少气道氧化应激损伤,减轻气道炎症反应。
Objective To explore the effects of sputum aspiration and lavage under fiberoptic bronchoscopy on respiratory mechanics indicators,oxidative stress indicators,and MMP-9/TIMP-1 in patients with severe pneumonia,and observing their clinical effects.Methods From August 2019 to April 2023,162 patients with severe pneumonia were selected from Hohhot First Hospital.Using a random number table method,patients were divided into an observation group and a control group.Two groups of patients received routine treatments such as tracheal intubation,mechanical ventilation,and anti infection immediately after admission.Patients in the control group were treated with sterile sputum aspiration through tracheal intubation on the basis of routine treatment.Patients in the observation group were treated with fiberoptic bronchoscopy for sputum aspiration and lavage on the basis of routine treatment.The clinical efficacy,respiratory mechanics index,oxidative stress index,MMP-9/TIMP-1 and lung moist rales disappearance time,antipyretic time were compared between the two groups.Results After treatment,the clinical total effective rate in the observation group was 85.19%,significantly higher than the 70.37%in the control group(χ^(2)=5.143,P<0.05).The RaW in the observation group was significantly lower than that in the control group(t=14.344,P<0.05),while the Cst in the observation group was significantly higher than that in the control group(t=15.436,P<0.05).The MDA level in the observation group was significantly lower than that in the control group(t=14.200,P<0.05).Additionally,the SOD(t=16.754,P<0.05)and TAC(t=6.872,P<0.05)levels in the observation group were significantly higher than those in the control group(P<0.05).The serum MMP-9(t=9.433,P<0.05)and TIMP-1(t=16.353,P<0.05)levels in the observation group were significantly lower than those in the control group.Furthermore,the observation group showed shorter durations for disappearance of lung wet rales(t=4.680,P<0.05),and fever reduction(t=3.740,P<0.05)compared to the control group.Conclusion The application of bronchofiberscopy-guided sputum suction and lavage in severe pneumonia can effectively improve clinical efficacy,ameliorate respiratory mechanics indicators,reduce airway oxidative stress injury,and alleviate airway inflammatory response.
作者
赵珊珊
李勇
董建华
ZHAO Shanshan;LI Yong;DONG Jianhua(The First Hospital of Hohhot,Hohhot Inner Mongolia Autonomous Region 010000,China)
出处
《中国急救复苏与灾害医学杂志》
2025年第8期1079-1082,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
重症肺炎
纤维支气管镜吸痰灌洗
基质金属蛋白酶-9
基质金属蛋白酶抑制剂
Severe pneumonia
Sputum aspiration and lavage by fiberoptic bronchoscopy
Matrix metalloprotein-9
Tissue inhibitor of matrix metalloproteinase-1
