CAJ | 학술논문

目的：探讨纤维支气管镜对严重呼吸机相关性肺炎患者临床症状及呼吸力学参数的影响，为临床制定干预措施提供依据。方法选取医院2011年6月－2014年10月收治的80例严重呼吸机相关性肺炎患者作为研究对象，随机分为观察组和对照组，每组各40例，两组患者确诊后均给予常规抗菌药物治疗，对照组在此基础上给予常规灌洗吸痰，观察组则给予纤维支气管镜肺泡灌洗吸痰治疗，对治疗过程中两组患者的呼吸力学参数、肺部感染情况及临床疗效进行比较分析。结果观察组在治疗1 h和4 h后气道峰压（PIP）、动态顺应性（Cdyn）、气道阻力（Raw ）及呼吸功（WOB）参数均明显优于对照组；治疗后两组患者CPIS评分相比治疗前均有不同程度改善，观察组治疗3、5、7 d的评分相比对照组明显降低；治疗后观察组痊愈29例占72．5％，显效9例占22．5％，对照组痊愈16例占40．0％，显效18例占45．0％，差异有统计学意义（ P＜0．05）。结论纤维支气管镜肺泡灌洗吸痰治疗严重呼吸机相关性肺炎可有效改善患者的临床感染症状和呼吸功能，具有显著的临床疗效。
목적：탐토섬유지기관경대엄중호흡궤상관성폐염환자림상증상급호흡역학삼수적영향，위림상제정간예조시제공의거。방법선취의원2011년6월－2014년10월수치적80례엄중호흡궤상관성폐염환자작위연구대상，수궤분위관찰조화대조조，매조각40례，량조환자학진후균급여상규항균약물치료，대조조재차기출상급여상규관세흡담，관찰조칙급여섬유지기관경폐포관세흡담치료，대치료과정중량조환자적호흡역학삼수、폐부감염정황급림상료효진행비교분석。결과관찰조재치료1 h화4 h후기도봉압（PIP）、동태순응성（Cdyn）、기도조력（Raw ）급호흡공（WOB）삼수균명현우우대조조；치료후량조환자CPIS평분상비치료전균유불동정도개선，관찰조치료3、5、7 d적평분상비대조조명현강저；치료후관찰조전유29례점72．5％，현효9례점22．5％，대조조전유16례점40．0％，현효18례점45．0％，차이유통계학의의（ P＜0．05）。결론섬유지기관경폐포관세흡담치료엄중호흡궤상관성폐염가유효개선환자적림상감염증상화호흡공능，구유현저적림상료효。
OBJECTIVE To study the influence of fiberoptic bronchoscopy on the clinical symptoms and respiratory mechanical parameters of the patients with severe ventilator‐associated pneumonia so as to put forward clinical in‐terventions .METHODS A total of 80 patients with severe ventilator‐associated pneumonia who were treated in the hospital from Jun 2011 to Oct 2014 were recruited as the study objects and randomly divided into the observation group and the control group ,with 40 cases in each .Both groups were treated with conventional antibiotics after the diagnosis ,the control group was given the additional conventional antibiotics ,while the observation group was treated with bronchotracho alveolar larvage and suctioning under fiberoptic bronchoscopy .The respiratory me‐chanical parameters ,prevalence of pulmonary infections ,and clinical efficacy were observed and compared between the two groups during the treatment process .RESULTS After the treatment for 1 or 4 hours ,the parameters such as the peak airway pressure ,dynamic compliance ,airway resistance ,and work of breathing of the observation group were significantly better than those of the control group .The CPIS scores of both groups were improved to some extent after the treatment ,and the CPIS scores on day 3 ,5 ,and 7 of the observation group were significant‐ly less than those of the control group .After the treatment ,29 (72 .5% ) cases were cured in the observation group ,16 (40 .0% ) cases in the control group ;9 (22 .5% ) cases were effective in the observation group ,18 (45 .0% ) cases in the control group ,and there was statistically significant (P<0 .05) .CONCLUSION As for the treatment of the patients with severe ventilator‐associated pneumonia ,the bronchotracho alveolar larvage and suc‐tioning under fiberoptic bronchoscopy can achieve remarkable clinical effect on improving the clinical symptoms of infections and respiratory function .