摘要
目的探究纤支镜抗生素灌洗联合乙酰半胱氨酸对重症呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的临床疗效,并分析其对肺泡灌洗液相关因子、肺机械力学及动脉血气的影响。方法选取信阳市人民医院2019年6月—2021年6月期间收治的150例重症VAP患者,采用随机数字表法分为研究组75例和对照组75例,比较两组临床疗效、肺泡灌洗液白介素-32(interleukin-32,IL-32)、可溶性髓系细胞触发受体-1(soluble myeloid cell trigger receptor-1,sTREM-1)、微小RNA-127-5p(micro RNA-127-5p,miR-127-5p)、肺机械力学指标、动脉血气指标和不良反应。结果研究组显效率高于对照组(P<0.05)。治疗前两组患者肺泡灌洗液IL-32、sTREM-1、miR-127-5p无统计学差异(P>0.05),治疗后两组患者肺泡灌洗液IL-32、sTREM-1低于治疗前(P<0.05),miR-127-5p高于治疗前(P<0.05),且研究组肺泡灌洗液IL-32、sTREM-1低于对照组(P<0.05),miR-127-5p高于对照组(P<0.05)。治疗前两组患者动态肺顺应性(dynamic lung compliance,CLdyn)、气道峰压(peak inspiratory pressure,PIP)、呼吸做功(work of breathing,WOB)无统计学差异(P>0.05),治疗后两组患者CLdyn升高于治疗前(P<0.05),研究组CLdyn高于对照组(P<0.05),PIP、WOB低于治疗前(P<0.05),研究组PIP、WOB低于对照组(P<0.05)。治疗前两组患者血氧饱和度(Oxygen saturation,SaO_(2))、氧分压(partial pressure of oxygen,PaO_(2))、二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO_(2))无统计学差异(P>0.05),治疗后两组患者SaO_(2)、PaO_(2)、氧合指数高于治疗前(P<0.05),PaCO_(2)低于治疗前(P<0.05),且研究组SaO_(2)、PaO_(2)高于对照组(P<0.05),PaCO_(2)低于对照组(P<0.05)。两组心律失常、低氧血症、气道黏膜出血、恶心呕吐等不良反应总发生率无统计学差异(P>0.05)。结论纤支镜抗生素灌洗联合乙酰半胱氨酸治疗重症VAP患者疗效良好,可以有效抑制患者肺部炎症和病原菌感染,改善患者肺呼吸功能,提升患者氧合功能,且安全性良好。
Objective To explore the effect of bronchoscopic antibiotic lavage combined with acetylcysteine in patients with severe ventilator associated pneumonia(VAP),and analyze the effect of ventilator associated pneumonia on factors associated with alveolar lavage fluid,pulmonary mechanics and arterial blood gas.Methods A total of 150 patients with severe VAP admitted to Xinyang Central Hospital were enrolled between June 2019 and June 2021.According to random number table method,they were divided into study group and control group,75 cases in each group.The clinical curative effect,levels of IL-32,sTREM-1 and miR-127-5p in alveolar lavage fluid,lung machinery mechanics indeeffective rate in study group was significantly higher than that in control group(P<0.05).Before treatment,there was no significant difference in levels of interleukin-32(IL-32),soluble myeloid cell trigger receptor-1(sTREM-1)and microRNA-127-5p(miR-127-5p)in alveolar lavage fluid between the two groups(P>0.05).After treatment,levels of IL-32 and sTREM-1 were decreased,while miR-127-5p level was increased in both groups(P<0.05).The levels of IL-32 and sTREM-1 in study group were lower than those in control group(P<0.05)while miR-127-5p level was higher than that in control group(P<0.05).Before treatment,there was no significant difference in dynamic lung compliance(CLdyn),peak inspiratory pressure(PIP)or work of breathing(WOB)between the two groups(P>0.05).After treatment,CLdyn was increased(P<0.05),while PIP and WOB were decreased in both groups(P<0.05).CLdyn in study group was higher than control group(P<0.05),while PIP and WOB were lower than control group(P<0.O5).Before treatment,there was no significant difference in oxygen saturation(SaO_(2)),partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))(P>0.05).After treatment,SaO_(2)and PaO_(2)were increased(P<0.05),while PaCO_(2)was decreased in both groups(P<0.05).SaO_(2),PaO_(2)and Oxygenation index in study group were higher than those in control group(P<0.05),while PaCO_(2)was lower than that in control group(P<0.05).There was no significant difference such as arrhythmia,hypoxemia,airway mucosal hemorrhage,nausea and vomiting between the two groups(P>0.O5).Conclusion The curative effect of fiberoptic bronchoscopic antibiotics lavage combined with acetylcysteine for aerosol inhalation is good on patients with severe VAP.which can effectively inhibit lung inflammation and pathogens infection,improve lung respiratory function and oxygenation function,with high safety.
作者
孙玉宝
王誉翔
吴润明
余金鸣
王小雯
SUN Yun-bao;WANG Yu-xiang;WU Run-ming;YU Jin-ming;WANG Xiao-wen(Intensive Care Unit,Xinyang Peoples Hospital,Xinyang,Henan 464000,China;Intensive Care Unit,Zhengzhou Peoples Hospital,Zhengzhou,Henan 450000,China)
出处
《医药论坛杂志》
2025年第20期2165-2170,共6页
Journal of Medical Forum
基金
河南省医学科技攻关计划联合共建项目(LHGJ20230720)。
