向志+贺兼斌+何微

[摘要] 目的 探討分析重症老年细菌性肺炎患者应用抗生素支气管肺泡灌洗等治疗对肺功能及炎症介质的影响。 方法 选取2015年1月～2016年11月怀化市第一人民医院收治的重症老年细菌性肺炎患者60例，根据随机数字表法分为观察组和对照组，每组各30例。对照组静脉给予抗生素等治疗，观察组在在对照组的基础上加用抗生素支气管肺泡灌洗治疗。比较两组患者治疗前后一秒钟用力呼气容积（FEV1）、最大呼气流量（PEFR）、最大自主通气量（MVV）等肺功能指标以及内毒素（LPS）、肿瘤坏死因子-2（TNF-2）和白细胞介素-6（IL-6）等炎症因子。 结果 治疗前，两组FEV1、PEFR、MVV%比较，差异无统计学意义（P > 0.05）；治疗后，两组FEV1、PEFR、MVV%均较前明显改善，且观察组患明显优于对照组，差异有统计学意义（P < 0.05）。治疗前，两组LPS、TNF-2、IL-6比较，差异无统计学意义（P > 0.05）；治疗后，两组LPS、TNF-2、IL-6均较治疗前明显改善，且观察组明显优于对照组，差异有统计学意义（P < 0.05）。 结论 应用抗生素支气管肺泡灌洗等治疗在重症老年细菌性肺炎患者的临床治疗中，可以有效地改善患者的肺功能，有效地控制、缓解患者肺部炎症情况，在其应用治疗中具有较好的临床治疗效果，值得临床上进一步推广应用。

[关键词] 重症细菌性肺炎；老年患者；支气管肺泡灌洗；抗生素；肺功能；炎症介质

[中图分类号] R562.22 [文献标识码] A [文章编号] 1673-7210（2017）09（a）-0058-04

[Abstract] Objective To investigate and analyze of the effect of antibiotic bronchoalveolar lavage on pulmonary function and inflammatory mediators in patients with severe bacterial pneumonia. Methods From January 2015 to November 2016， in Huaihua First People's Hospital， 60 patients with severe bacterial pneumonia were selected， according to the random number table method， they were divided into observation group and control group， with 30 cases in each group. The control group was treated with antibiotics by intravenous administration， and the observation group was treated with antibiotic by bronchoalveolar lavage on the basis of the control group. The lung function index of forced epiratory volume in one second （FEV1）， peak expiratory flow rate （PEFR） and max volume value （MVV）， the inflammatory factor of lipopolysaccharide （LPS）， tumor necrosis factor-2 （TNF-2） and interleukin-6 （IL-6） before and after treatment in two groups were compared. Results Before the treatment， the FEV1， PEFR， MVV in two groups were compared， the differences were not statistically significant （P > 0.05）， after the treatment， the FEV1， PEFR， MVV in two groups were significantly better than before the treatment， the differences were statistically significant （P < 0.05）， and observation group were significantly better than the control group， the differences were statistically significant （P < 0.05）. Before the treatment， the LPS， TNF-2 and IL-6 in two groups were compared， the differences were not statistically significant （P > 0.05）， after the treatment， the LPS， TNF-2 and IL-6 in two groups were significantly better than before the treatment， the differences were statistically significant （P < 0.05）， and observation group were significantly better than the control group， the differences were statistically significant （P < 0.05）. Conclusion Application of antibiotic bronchoalveolar lavage in the treatment of elderly patients with severe bacterial pneumonia can effectively improve the patient's lung function， effectively control and alleviate the lung inflammation， the application of treatment have good clinical effect， and it′s worthy of further clinical application.endprint

[Key words] Severe bacterial pneumonia； Elderly patients； Bronchoalveolar lavage； Antibiotics； Pulmonary function； Inflammatory mediators

重症细菌性肺炎作为目前临床上患病率与死亡率均较高的疾病之一，严重威胁着患者的生命安全以及临床治疗。在既往的统计研究中发现，重症细菌性肺炎的患者致死率约占全部感染性疾病的30%，临床致死率较高[1-2]。目前随着抗生素应用的不断加重，各种细菌性肺炎的发病率也呈逐年增加的趋势，重症老年肺炎患者由于其自身因素、年龄大、脏器功能减退以及免疫机制下降等原因，患者治疗难度最大，危险性最高，是重症细菌性肺炎中死亡率较高的群体[3-4]。因此……