CAJ | 학술논문

目的：观察支气管肺泡灌洗( bronchoalveolar lavage, BAL)治疗重型颅脑损伤合并肺部感染的效果及安全性。方法选择我院收治的重型颅脑损伤合并肺部感染患者78例,采用随机数字表法分为观察组和对照组各39例。两组均给予常规治疗,观察组于确诊肺部感染后首日即予BAL治疗。观察两组治疗前及治疗后1、3、5日血气分析指标[血氧分压( PaO2)、动脉血二氧化碳分压( PaCO2)、氧合指数( PaO2/FiO2)],炎性因子[白细胞介素-6( IL-6)、肿瘤坏死因子-α( TNF-α)]及预后指标[机械通气天数、重症监护病房( ICU)住院天数、抗生素使用天数、肺部感染持续时间及28 d病死率]的变化,并记录并发症发生情况。结果两组治疗后PaO2、PaCO2、PaO2/FiO2、IL-6、TNF-α均较治疗前改善,且治疗后各时间点上述指标均优于对照组,差异均有统计学意义(P<0．05)。观察组机械通气天数、ICU住院天数、抗生素使用天数、肺部感染持续时间均显著短于对照组( P<0．05),两组28 d病死率比较差异无统计学意义(P>0．05)。观察组无严重BAL相关并发症发生。结论 BAL治疗可显著改善重型颅脑损伤合并肺部感染患者氧合功能,控制肺部炎症。
목적：관찰지기관폐포관세( bronchoalveolar lavage, BAL)치료중형로뇌손상합병폐부감염적효과급안전성。방법선택아원수치적중형로뇌손상합병폐부감염환자78례,채용수궤수자표법분위관찰조화대조조각39례。량조균급여상규치료,관찰조우학진폐부감염후수일즉여BAL치료。관찰량조치료전급치료후1、3、5일혈기분석지표[혈양분압( PaO2)、동맥혈이양화탄분압( PaCO2)、양합지수( PaO2/FiO2)],염성인자[백세포개소-6( IL-6)、종류배사인자-α( TNF-α)]급예후지표[궤계통기천수、중증감호병방( ICU)주원천수、항생소사용천수、폐부감염지속시간급28 d병사솔]적변화,병기록병발증발생정황。결과량조치료후PaO2、PaCO2、PaO2/FiO2、IL-6、TNF-α균교치료전개선,차치료후각시간점상술지표균우우대조조,차이균유통계학의의(P<0．05)。관찰조궤계통기천수、ICU주원천수、항생소사용천수、폐부감염지속시간균현저단우대조조( P<0．05),량조28 d병사솔비교차이무통계학의의(P>0．05)。관찰조무엄중BAL상관병발증발생。결론 BAL치료가현저개선중형로뇌손상합병폐부감염환자양합공능,공제폐부염증。
Objective To observe the effects and safety of bronchoalveolar lavage ( BAL) in patients with pulmonary infection after severe traumatic brain injury. Methods Patients were randomly divided into the treatment group and the con-trol group (n=39, each) using random digit table. All the patients were treated with conventional therapy, and the treatment group was treated with BAL besides conventional therapy. Results The results of blood gas analysis showed that the levels of PaO2 and PaO2/FiO2 in the treatment group were significantly higher than that of the control group (P<0. 05), while the lev-el of PaO2 was significantly lower than that of the control group ( P<0. 05 ) . Compared with the control group at the same time, the plasma IL-6 and TNF-αlevels were obviously lower than those before treatment, and the levels were decreased more significantly in the treatment group than that in the control group. Duration of ICU stay, days of antibiotic use, and days of mechanical ventilation were significantly fewer in the treatment group than that in the control group. There was no significant difference in mortality rate between the two groups (P>0. 05). There was no serious BAL related complications in the treat-ment group. Conclusion The BAL can significantly increase the oxygenation, control the pulmonary infection.