摘要
目的分析高频胸壁振荡排痰(high-frequency chest wall oscillation expectoration,HFCWOE)与传统气道廓清术(traditional airway clearance techniques,TACT)治疗重症肺炎的临床疗效。方法回顾性收集71例重症肺炎患者,根据治疗方法分为对照组39例和观察组32例。对照组实施纤维支气管镜肺泡冲洗联合TACT治疗。观察组实施纤维支气管镜肺泡冲洗联合HFCWOE治疗。比较临床疗效、临床症状缓解时间、肺功能、血气指标、炎症反应递质水平及免疫功能。结果观察组治疗后,治疗有效率87.50%、最大呼气流量(peak expiratory flow,PEF)(2.93±0.38)L/s、用力肺活量(forced vital capacity,FVC)(2.61±0.33)L、1 s用力呼气容积(forced expiratory volume in 1 second,FEV_(1))(2.28±0.26)L、动脉氧分压(partial pressure of O_(2),PaO_(2))(83.27±7.24)mmHg、PaO_(2)/吸入氧浓度(fraction of inspiration O_(2),FiO_(2))(341.86±37.54)mmHg、T淋巴细胞CD3^(+)(CD3^(+)T cell,CD3^(+))(62.53±11.28)%、自然杀伤细胞(natural killer cell,NK)(15.76±3.51)%高于对照组66.67%、(2.74±0.29)L/s、(2.42±0.28)L、(2.13±0.17)L、(78.92±6.86)mmHg、(320.63±42.79)mmHg、(55.78±10.36)%、(13.92±2.98)%(P<0.05)。观察组肺部湿啰音消失时间(5.30±1.16)d、咳痰缓解时间(4.89±1.07)d短于对照组(5.96±1.28)d、(5.46±1.19)d(P<0.05)。观察组二氧化碳分压(partial pressure of CO_(2),PaCO_(2))(41.63±5.19)mmHg、中性粒细胞弹性蛋白酶(neutrophil elastas,NE)(10.34±2.36)ng/L、可溶性髓样细胞触发性受体-1(soluble form of triggering receptors expressed on myeloid cell-1,sTREM-1)(24.31±3.27)ng/L、白细胞介素-10(interleukin-10,IL-10)(19.54±3.22)ng/L、T淋巴细胞CD8^(+)(CD8^(+)T cell,CD8^(+))(24.63±3.58)%低于对照组(44.52±4.71)mmHg、(11.94±2.75)ng/L、(26.82±4.19)ng/L、(21.73±4.16)ng/L、(27.09±4.45)%(P<0.05)。结论HFCWOE对重症肺炎患者有良好临床效果,相较TACT,可缩短患者临床症状缓解时间,改善患者肺功能和免疫功能,调节患者血气水平,减轻炎症反应。
Objective To analyze the clinical efficacy of high-frequency chest wall oscillation expectoration(HFCWOE)versus traditional airway clearance techniques(TACT)in the treatment of severe pneumonia.Methods A retrospective analysis was conducted on 71 elderly patients with severe pneumonia,divided into control group 39 cases and observation group 32 cases according to the distinct treatment methods they received.Control group received fiberoptic bronchoscopic alveolar lavage combined with TACT.Observation group received fiberoptic bronchoscopic alveolar lavage combined with HFCWO.Clinical efficacy,symptom relief time,lung function,blood gas parameters,inflammatory mediator levels,and immune function were compared between the two groups.Results After treatment,The total response rate of observation group was 87.50%,peak expiratory flow(PEF)(2.93±0.38)L/s,forced vital capacity(FVC)(2.61±0.33)L,forced expiratory volume in 1 second(FEV_(1))(2.28±0.26)L,partial pressure of O_(2)(PaO_(2))(83.27±7.24)mmHg,PaO_(2)/fraction of inspiration O_(2)(FiO_(2))(341.86±37.54)mmHg,CD3^(+)T cell(CD3^(+))(62.53±11.28)%and natural killer cell(NK)(15.76±3.51)%were higher than those in control group 66.67%,(2.74±0.29)L/s,(2.42±0.28)L,(2.13±0.17)L,(78.92±6.86)mmHg,(320.63±42.79)mmHg,(55.78±10.36)%,(13.92±2.98)%(P<0.05).The disappearance time of lung wet rale(5.30±1.16)d,sputum relief time(4.89±1.07)d in observation group were shorter than those in control group(5.96±1.28)d,(5.46±1.19)d(P<0.05).partial pressure of CO_(2)(PaCO_(2))(41.63±5.19)mmHg,neutrophil elastas(NE)(10.34±2.36)ng/L,soluble form of triggering receptors expressed on myeloid cell-1(sTREM-1)(24.31±3.27)ng/L,interleukin-10(IL-10)(19.54±3.22)ng/L,CD8^(+)T cell(CD8^(+))(24.63±3.58)%in observation group were lower than those in control group(44.52±4.71)mmHg,(11.94±2.75)ng/L,(26.82±4.19)ng/L,(21.73±4.16)ng/L,(27.09±4.45)%(P<0.05).Conclusions HFCWOE has good clinical effect on patients with severe pneumonia.Compared with the use of TACT,it can shorten the time of relieving clinical symptoms,improve lung function and immune function of patients,regulate blood gas level of patients,and reduce inflammatory response.
作者
刘虹
李国蓉
战祥哲
高海燕
刘洪千
赵永辉
Liu Hong;Li Guorong;Zhan Xiangzhe;Gao Haiyan;Liu Hongqian;Zhao Yonghui(Department of Respiratory and Critical Care Medicine,Qinghai University Affiliated Hospital,Xining 810000,China;Clinical College of Qinghai University,Xining 810000,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第5期802-806,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
关键词
重症肺炎
高频胸壁振荡排痰
传统气道廓清术
肺功能
Severe pneumonia
High-frequency chest wall oscillation
Traditional airway clearance techniques
Lung function
