中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2015年
4期
374-379
,共6页
胸部CT%X线%纤维支气管镜%气道灌洗%无痛%机械通气%肺部感染%重症监护室
胸部CT%X線%纖維支氣管鏡%氣道灌洗%無痛%機械通氣%肺部感染%重癥鑑護室
흉부CT%X선%섬유지기관경%기도관세%무통%궤계통기%폐부감염%중증감호실
CT chest%X-ray%Fiberoptic bronchoscopy%Bronchial lavage%Painless%Mechanical ventilation%Pulmonary infection%Intensive care unit
目的 探讨胸部CT定位下床旁无痛纤维支气管镜(bronchofibroscope,BFS)气道灌洗治疗机械通气合并重症肺部感染中的临床疗效.方法 应用无痛纤维支气管镜气道灌洗(bronchoalveolar lavage,BAL)对重症医科大学重症医学科内131例机械通气合并重症肺部感染患者随机(随机数字法)分为CT检查组(C组)、X线胸片检查组(X组)和未做放射检查组(N组),三组患者均行有创呼吸机辅助通气,后行无痛纤维支气管镜气道灌洗治疗.监测患者生命体征,灌洗前和灌洗后1h、2h、4h的呼吸力学指标,同时记录BAL持续时间,监测术后3d、5d感染相关性指标,有效病原菌检出率、有创机械通气时间和机械通气时间.对三组各项监测指标进行统计学对比分析.结果 术中及术后10 min,C组和X组的心率(HR)、呼吸频率(Br)低于N组,差异具有统计学意义(P＜0.05),收缩压(SBP)、舒张压(DBP)组间差异无统计学意义(P＞0.05).C组、X组灌洗后1h、2h气道峰压(PIP)、呼吸功(WOBvent)和吸气阻力(RAW)均低于N组,肺动态顺应性(Cdyn)优于N组(P＜0.05);C组、X组灌洗后4 h Cdyn优于N组(P＜0.05),PIP、WOBvent和RAW差异无统计学意义(P＞0.05).C组机械通气时间(MV-t)为(16.81 ±2.62) min,较X组(20.12 ±3.81)min、N组(23.69 ±2.76) min均短(P＜0.05).BAL治疗后3d,C组、X组中心体温(T)、外周血WBC计数(WBC)和降钙素原(PCT)降低低于N组(P＜0.05),且C组低于X组(P＜0.05),BAL治疗后5d,C组、X组WBC和PCT降低低于N组(P＜0.05),且C组低于X组(P＜0.05).C组有效病原菌检出率为80.55％(29/36),较X组(72.09％,31/43)、N组(59.65％,34/57)均高(P＜0.05).C组MV-t为(114.36±38.39)h,较X组(132.07 ±42.51)h、N组(165.28 ±67.28)h均短(P＜0.05).结论 对机械通气合并重症肺部感染患者使用胸部CT定位下无痛纤维支气管镜气道灌洗治疗能有效降低应激状态,减轻气道高反应性,缩短手术时间,提高肺部感染病灶引流,增加有效病原菌检出率、缩短ICU住院时间及机械通气时间,提高该类患者综合救治水平.
目的 探討胸部CT定位下床徬無痛纖維支氣管鏡(bronchofibroscope,BFS)氣道灌洗治療機械通氣閤併重癥肺部感染中的臨床療效.方法 應用無痛纖維支氣管鏡氣道灌洗(bronchoalveolar lavage,BAL)對重癥醫科大學重癥醫學科內131例機械通氣閤併重癥肺部感染患者隨機(隨機數字法)分為CT檢查組(C組)、X線胸片檢查組(X組)和未做放射檢查組(N組),三組患者均行有創呼吸機輔助通氣,後行無痛纖維支氣管鏡氣道灌洗治療.鑑測患者生命體徵,灌洗前和灌洗後1h、2h、4h的呼吸力學指標,同時記錄BAL持續時間,鑑測術後3d、5d感染相關性指標,有效病原菌檢齣率、有創機械通氣時間和機械通氣時間.對三組各項鑑測指標進行統計學對比分析.結果 術中及術後10 min,C組和X組的心率(HR)、呼吸頻率(Br)低于N組,差異具有統計學意義(P＜0.05),收縮壓(SBP)、舒張壓(DBP)組間差異無統計學意義(P＞0.05).C組、X組灌洗後1h、2h氣道峰壓(PIP)、呼吸功(WOBvent)和吸氣阻力(RAW)均低于N組,肺動態順應性(Cdyn)優于N組(P＜0.05);C組、X組灌洗後4 h Cdyn優于N組(P＜0.05),PIP、WOBvent和RAW差異無統計學意義(P＞0.05).C組機械通氣時間(MV-t)為(16.81 ±2.62) min,較X組(20.12 ±3.81)min、N組(23.69 ±2.76) min均短(P＜0.05).BAL治療後3d,C組、X組中心體溫(T)、外週血WBC計數(WBC)和降鈣素原(PCT)降低低于N組(P＜0.05),且C組低于X組(P＜0.05),BAL治療後5d,C組、X組WBC和PCT降低低于N組(P＜0.05),且C組低于X組(P＜0.05).C組有效病原菌檢齣率為80.55％(29/36),較X組(72.09％,31/43)、N組(59.65％,34/57)均高(P＜0.05).C組MV-t為(114.36±38.39)h,較X組(132.07 ±42.51)h、N組(165.28 ±67.28)h均短(P＜0.05).結論 對機械通氣閤併重癥肺部感染患者使用胸部CT定位下無痛纖維支氣管鏡氣道灌洗治療能有效降低應激狀態,減輕氣道高反應性,縮短手術時間,提高肺部感染病竈引流,增加有效病原菌檢齣率、縮短ICU住院時間及機械通氣時間,提高該類患者綜閤救治水平.
목적 탐토흉부CT정위하상방무통섬유지기관경(bronchofibroscope,BFS)기도관세치료궤계통기합병중증폐부감염중적림상료효.방법 응용무통섬유지기관경기도관세(bronchoalveolar lavage,BAL)대중증의과대학중증의학과내131례궤계통기합병중증폐부감염환자수궤(수궤수자법)분위CT검사조(C조)、X선흉편검사조(X조)화미주방사검사조(N조),삼조환자균행유창호흡궤보조통기,후행무통섬유지기관경기도관세치료.감측환자생명체정,관세전화관세후1h、2h、4h적호흡역학지표,동시기록BAL지속시간,감측술후3d、5d감염상관성지표,유효병원균검출솔、유창궤계통기시간화궤계통기시간.대삼조각항감측지표진행통계학대비분석.결과 술중급술후10 min,C조화X조적심솔(HR)、호흡빈솔(Br)저우N조,차이구유통계학의의(P＜0.05),수축압(SBP)、서장압(DBP)조간차이무통계학의의(P＞0.05).C조、X조관세후1h、2h기도봉압(PIP)、호흡공(WOBvent)화흡기조력(RAW)균저우N조,폐동태순응성(Cdyn)우우N조(P＜0.05);C조、X조관세후4 h Cdyn우우N조(P＜0.05),PIP、WOBvent화RAW차이무통계학의의(P＞0.05).C조궤계통기시간(MV-t)위(16.81 ±2.62) min,교X조(20.12 ±3.81)min、N조(23.69 ±2.76) min균단(P＜0.05).BAL치료후3d,C조、X조중심체온(T)、외주혈WBC계수(WBC)화강개소원(PCT)강저저우N조(P＜0.05),차C조저우X조(P＜0.05),BAL치료후5d,C조、X조WBC화PCT강저저우N조(P＜0.05),차C조저우X조(P＜0.05).C조유효병원균검출솔위80.55％(29/36),교X조(72.09％,31/43)、N조(59.65％,34/57)균고(P＜0.05).C조MV-t위(114.36±38.39)h,교X조(132.07 ±42.51)h、N조(165.28 ±67.28)h균단(P＜0.05).결론 대궤계통기합병중증폐부감염환자사용흉부CT정위하무통섬유지기관경기도관세치료능유효강저응격상태,감경기도고반응성,축단수술시간,제고폐부감염병조인류,증가유효병원균검출솔、축단ICU주원시간급궤계통기시간,제고해류환자종합구치수평.
Objective To explore the effects of bed side painless fiberoptic bronchoscopy for bronchoalveolar lavage (BAL) under chest computed tomography (CT) guidance and mechanical ventilation in the patients with severe pulmonary infection (SPI).Methods A total of 131 cases of SPI undermechanical ventilation support were randomly (random number) divided into CT group (C group),chest Xray examination group (X group) and without radiological examination group (N group).The bronchoalveolar lavage (BAL) by using painless fiberoptic bronchoscopy with invasive mechanical ventilation was carried out in patients of these three groups.Vital signs and variables of respiratory mechanics ofpatients were monitored before and 1 h,2 h,and 4 h after BAL and the time consumed for BAL was simultaneous recorded.Meanwhile,infection related biomarkers on the 3rd d and 5thd after BAL,positive detection rate of pathogenic bacteria,the time of invasive mechanical ventilation used during BAL and total duration of mechanical ventilation support were measured.Results During BAL and at 10 min after BAL,heart rate and respiratory rate of C group and X group were lower than those of N group (P ＜ 0.05),however,there was no significant difference in SBP and DBP among groups (P ＞ 0.05).One and two hours after BAL,peak inspiratory pressure (PIP),work of breathing ventilation (WOBvent) and airway resistance (RAW) in C group and X group were lower than those in N group,therefore,dynamic compliance (Cdyn) in C and X groups was better than that in N group (P ＜0.05).Four hours after BAL.Cdyn in C group and X group was better than that in N group (P ＜ 0.05),But there were no significant differences in PIP,WOBvent and RAW among groups (P ＞ 0.05).BAL time (BAL-t) in C group (16.81 ±2.62) min was shorter than that in X group (20.12 ± 3.81) min and N group (23.69 ± 2.76) min,(P ＜ 0.05).Three and five days after BAL,core body temperature,WBC and procalcitonin (PCT) in C and X group were lower than those in N group (P ＜0.05),and those in C group was lower than those in X group (P ＜0.05).Pathogenic micro-organism detection rate in C group (80.55％,29/36) was higher than that in X group (72.09％,31/43) and N group (59.65％,34/57) (P ＜ 0.05).Total mechanical ventilation time (MV-t) in C group (114.36 ± 38.39) h was shorter than that in X group (132.07 ± 42.51) h and N group (165.28 ± 67.28) h (P ＜ 0.05).Conclusions BAL by using painless fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation,decrease airway hyper-reactivity,shorten the BAL time,ICU stay and duration of mechanical ventilation,facilitate drainage of lung infection exudates and pathogen detection rate and improve efficacy of comprehensive treatment.
