CAJ | 학술논문

目的：比较分析纤维支气管镜与常规吸痰治疗在预防呼吸机相关性肺炎( VAP)患者中的应用价值及对VAP病原学的诊断价值。方法将70例呼吸衰竭并行呼吸机辅助呼吸的患者按照随机数字表法分为观察组和对照组，各35例，对照组患者采用常规吸痰管吸痰，观察组患者采用纤维支气管镜吸痰，观察两组行呼吸机辅助呼吸后VAP发生率、机械通气情况、住院时间、活动状态和生活质量，并进行痰中病原学分析。结果每例患者各进行2次痰细菌培养，观察组检出阳性率82．86%，对照组检出阳性率57．14%，比较差异有统计学意义(P<0．05)；观察组患者行辅助呼吸后3、5、7d肺部感染评分(CPIS)明显低于对照组，比较差异有统计学意义(P<0．05)；观察组VAP发生例数、机械通气时间、VAP治愈时间、总住院时间均明显低于对照组，比较差异有统计学意义( P<0．05)；治疗后3个月，观察组卡氏评分( KPS )及日常生活能力评分(ADL)均明显优于对照组(P<0．05)。结论对呼吸衰竭机械通气患者行纤维支气管镜吸痰进行痰培养可以有效的进行病原菌监测，及早采取措施防止肺感染，可以解除呼吸道的阻塞、直接去除引起呼吸衰竭的诱因，缩短患者住院时间，改善预后，值得临床推广使用。
목적：비교분석섬유지기관경여상규흡담치료재예방호흡궤상관성폐염( VAP)환자중적응용개치급대VAP병원학적진단개치。방법장70례호흡쇠갈병행호흡궤보조호흡적환자안조수궤수자표법분위관찰조화대조조，각35례，대조조환자채용상규흡담관흡담，관찰조환자채용섬유지기관경흡담，관찰량조행호흡궤보조호흡후VAP발생솔、궤계통기정황、주원시간、활동상태화생활질량，병진행담중병원학분석。결과매례환자각진행2차담세균배양，관찰조검출양성솔82．86%，대조조검출양성솔57．14%，비교차이유통계학의의(P<0．05)；관찰조환자행보조호흡후3、5、7d폐부감염평분(CPIS)명현저우대조조，비교차이유통계학의의(P<0．05)；관찰조VAP발생례수、궤계통기시간、VAP치유시간、총주원시간균명현저우대조조，비교차이유통계학의의( P<0．05)；치료후3개월，관찰조잡씨평분( KPS )급일상생활능력평분(ADL)균명현우우대조조(P<0．05)。결론대호흡쇠갈궤계통기환자행섬유지기관경흡담진행담배양가이유효적진행병원균감측，급조채취조시방지폐감염，가이해제호흡도적조새、직접거제인기호흡쇠갈적유인，축단환자주원시간，개선예후，치득림상추엄사용。
Objective To compare the application value of fiberoptic bronchoscopy and conventional sputum suction therapy on prevention of ventilator-associated pneumonia ( VAP) and diagnostic value of the etiology of VAP. Methods 70 patients with respiratory failure using ventilator assisted breathing were randomly divided into the ob-servation group and the control group with 35 cases in each group. The control group was treated with conventional suction while the observation group was treated with fiber bronchoscope sputum. The rate of VAP after mechanical ventilation, duration of hospital stay, and activity and quality of life after using ventilator assisted breathing were re-corded. Results Every patient was given 2 times of sputum bacterial culture. The positive rate of the observation group was 82. 86% while the positive rate of the control group was 57. 14% ( P<0. 05 ) . The pulmonary infection score (CPIS) was significantly lower in the observation group than in the control group (P<0. 05). The incidence of VAP, mechanical ventilation time, VAP cure time, duration of hospital stay were significantly lower in the observa-tion group than in the control group (P<0. 05). 3 months after the treatment, Karnofsky score (KPS) and activity of daily living ( ADL) score was significantly better in the observation group than in the control group ( P <0. 05 ) . Conclusion The sputum culture can effectively monitor the pathogens for the mechanical ventilation of respiratory failure patients underwent fiberoptic bronchoscopy sputum suction, and early measures of pulmonary infection can re-lieve the obstruction of respiratory tract and the immediate removal of the main causes of respiratory failure, which can shorten the duration of hospital stay and improve their prognosis.