CAJ | 학술논문

目的：探讨纤维支气管镜检查和支气管肺泡灌洗对高位脊髓损伤患者呼吸机相关性肺炎的疗效。方法随机选取本院高位脊髓损伤患者需要机械通气已行气管切开确诊为呼吸机相关性肺炎患者（60例）作为研究对象，随机分为给予纤维支气管镜吸痰、支气管肺泡灌洗处理的治疗组（30例）和常规治疗的对照组（30例）。两组患者均采用抗生素、化痰、排痰药物、无菌吸痰管吸痰、机械排痰、体位引流等常规治疗措施。对患者治疗后不同时间的临床肺部感染评分（CPIS）、抗生素应用时间、住 ICU 时间、10天脱机成功率及2月死亡率等进行分析。结果治疗组治疗后 CPIS 评分较对照组明显下降，其抗生素应用时间缩短、住 ICU 时间缩短、呼吸机辅助通气时间缩短，较对照组有显著的统计学意义。结论对于高位脊髓损伤合并呼吸机相关性肺炎患者采取经纤维支气管镜吸痰结合支气管肺泡灌洗能明显提高疗效，值得临床推广应用。
목적：탐토섬유지기관경검사화지기관폐포관세대고위척수손상환자호흡궤상관성폐염적료효。방법수궤선취본원고위척수손상환자수요궤계통기이행기관절개학진위호흡궤상관성폐염환자（60례）작위연구대상，수궤분위급여섬유지기관경흡담、지기관폐포관세처리적치료조（30례）화상규치료적대조조（30례）。량조환자균채용항생소、화담、배담약물、무균흡담관흡담、궤계배담、체위인류등상규치료조시。대환자치료후불동시간적림상폐부감염평분（CPIS）、항생소응용시간、주 ICU 시간、10천탈궤성공솔급2월사망솔등진행분석。결과치료조치료후 CPIS 평분교대조조명현하강，기항생소응용시간축단、주 ICU 시간축단、호흡궤보조통기시간축단，교대조조유현저적통계학의의。결론대우고위척수손상합병호흡궤상관성폐염환자채취경섬유지기관경흡담결합지기관폐포관세능명현제고료효，치득림상추엄응용。
Objective To explore the curative effect of fiberoptic bronchoscopy combined with bronchoalveolar lavage in patients of high level spinal cord injury with ventilator-associated pneumonia. Methods Sixty patients of high-level spinal cord injury with mechanical ventilation through tracheotomy and acquired ventilator-associated pneumonia were randomly divid-ed into control group (n=30) and treatment group (n=30). The treatment group were treated with bronchoalveolar larvage fluid (BAL). The control group accepted routine treatment. All patients accepted anti-infection,nutritional support, dissipate phlegm, aspiration of sputum with germ free sputum tube, mechanical assistance for expulsion of phlegm,postural drainage treatments etc. The therapeutic effects in the two groups were evaluated and compared from clinical pulmonary infection score (CPISs), an-tibiotic application time, hospitalization days in ICU, 10 days offline success rate, 2 months mortality. Results CPISs, an-tibiotic application time, hospitalization days in ICU, time of mechanical ventilation of treatment group were shorter than those in control group (P<0.05). Conclusion Fiberoptic bronchoscopy combined with bronchoalveolar lavage is a safe and effective method to treat the patients with high level spinal cord injury combined with hypostatic pneumonia. It is worth application in clinic.