CAJ | 학술논문

目的探讨纤维支气管镜在老年人坠积性肺炎治疗中的临床价值.方法选取2012年5月至2014年5月在佛山市顺德区乐从医院呼吸内科住院的坠积性肺炎患者100例.根据治疗方案的不同将患者分为治疗组(n=50)和对照组(n=50).治疗组在常规治疗的基础上,行纤维支气管镜吸痰、灌洗及局部注药,经防污染毛刷取样或收集灌洗液行细菌培养;对照组常规治疗,常规取痰行细菌培养;根据细菌培养及药敏结果调整两组患者抗生素的使用.观察指标:治疗效果、死亡率、细菌培养结果、纤维支气管镜治疗的不良反应、住院时间.结果治疗组总有效率为84％,死亡率为8％;对照组总有效率为64％,死亡率为28％;两组比较差异有统计学意义(P＜0.05).治疗组细菌培养阳性率为88％,对照组为44％,差异有统计学意义(P＜0.05).治疗组革兰氏阴性致病菌占82.0％,对照组革兰氏阴性致病菌占86.4％;治疗后,治疗组细菌培养阴转率为86.4％,对照组为45.5％;两组对比,差异有统计学意义(P＜0.05).治疗组平均住院时间为(18.42±4.77)天,对照组为(23.06±6.08)天,差异有统计学意义(P＜0.05).纤维支气管镜治疗中未发生严重不良反应.结论应用纤维支气管镜治疗老年人坠积性肺炎效果良好,可降低死亡率,提高致病菌检出率,缩短住院时间,降低住院费用,且是安全的,值得临床推广应用.
목적 탐토섬유지기관경재노년인추적성폐염치료중적림상개치.방법 선취2012년5월지2014년5월재불산시순덕구악종의원호흡내과주원적추적성폐염환자100례.근거치료방안적불동장환자분위치료조(n=50)화대조조(n=50).치료조재상규치료적기출상,행섬유지기관경흡담、관세급국부주약,경방오염모쇄취양혹수집관세액행세균배양;대조조상규치료,상규취담행세균배양;근거세균배양급약민결과조정량조환자항생소적사용.관찰지표:치료효과、사망솔、세균배양결과、섬유지기관경치료적불량반응、주원시간.결과 치료조총유효솔위84％,사망솔위8％;대조조총유효솔위64％,사망솔위28％;량조비교차이유통계학의의(P＜0.05).치료조세균배양양성솔위88％,대조조위44％,차이유통계학의의(P＜0.05).치료조혁란씨음성치병균점82.0％,대조조혁란씨음성치병균점86.4％;치료후,치료조세균배양음전솔위86.4％,대조조위45.5％;량조대비,차이유통계학의의(P＜0.05).치료조평균주원시간위(18.42±4.77)천,대조조위(23.06±6.08)천,차이유통계학의의(P＜0.05).섬유지기관경치료중미발생엄중불량반응.결론 응용섬유지기관경치료노년인추적성폐염효과량호,가강저사망솔,제고치병균검출솔,축단주원시간,강저주원비용,차시안전적,치득림상추엄응용.
Objective To explore the clinical value of fiber bronchoscope in the treatment of elderly patients with hypostatic pneumonia.Methods 100 elderly patients with hypostatic pneumonia were selected from the Department of Respiratory Medicine at Lecong Hospital of Shunde,Foshan from May,2012 to May,2014.According to different treatment plans,the patients were divided into a treatment group(n=50)and a control group(n=50).In addition of routine treatment,the treatment group accepted sputum aspiration and lavage with bronchofibroscope; the specimens were sampled via protected specimen brush (PSB) or lavage for bacterial culture.The control group received routine treatment; sputum specimens were sampled routinely for bacterial culture.Antibiotics were used and adjusted according to the results of the bacterial culture and the drug sensitive test was carried out in both groups.The therapeutic effect,mortality,results of bacterial culture,hospital stays,and adverse effects of the treatment with fiber bronchoscope were observed.Results The total effective rate and the mortality were 84％ and 8％ in the treatment group and were 64％ and 28％ in the control group,with statistical differences(P ＜ 0.05).88％ patients of the treatment group and 44％ of the control group were positive in bacterial culture.82.0％ patients of the treatment group and 86.4％ of the matched group were positive in Gram negative pathogenic bacteria.After the treatment,the bacterial negative rate was 86.4％ in the treatment group and was 45.5％ in the control group,with a statistical difference(P ＜ 0.05).The mean time of hospital stay was (18.42 ± 4.77) days in the treatment group and was (23.06 ± 6.08) days in the control group,with a statistical difference(P ＜ 0.05).No severe adverse reactions occurred during the treatment with the fiber bronchoscope.Conclusions Fiber bronchoscope in the treatment of elderly patients with hypostatic pneumonia is effective and safe and can reduce the mortality,increase the detectable rate of pathogenic bacteria,shorten the hospital stay,and reduce the hospitalization expense.It is worth being clinically generalized.