吴嘉锟 司徒双苗 姚慧文 林福筹

【摘要】 目的：探討抗感染联合纤维支气管镜定位吸痰对重症肺炎患者肺功能及炎症反应的影响。方法：选取本院2018年2月-2019年12月74例ICU重症肺炎患者，按入组先后顺序编号，采用单双号将其分为对照组与研究组，每组37例。两组均行抗感染治疗，对照组采用密闭式吸痰管吸痰;研究组采用纤维支气管镜定位吸痰。比较两组的疗效及治疗前和治疗第7天的APACHEⅡ评分、肺动态顺应性（Cdyn）、浅快呼吸指数（RSB）、炎症反应指标。结果：研究组治疗总有效率高于对照组（P<0.05）。治疗第7天，两组APACHEⅡ评分均低于治疗前（P<0.05），且研究组低于对照组（P<0.05）;两组Cdyn、RSB均优于治疗前（P<0.05），且研究组均优于对照组（P<0.05）;两组IL-6、TNF-α、IL-10及PCT水平均低于治疗前（P<0.05），且研究组均低于对照组（P<0.05）。结论：抗感染联合纤维支气管镜定位吸痰可有效改善重症肺炎患者肺功能，减轻炎症反应，提升疗效。

【关键词】 抗感染 纤维支气管镜定位吸痰 重症肺炎 肺功能 炎症反应

Effect of Anti-Infection Combined with Fiberoptic Bronchoscopy Locates Sputum Aspiration on Lung Function and Inflammation Response in Patients with Severe Pneumonia/WU Jiakun， SITU Shuangmiao， YAO Huiwen， LIN Fuchou. //Medical Innovation of China， 2021， 18（13）： -130

[Abstract] Objective： To explore the effect of anti-infection combined with fiberoptic bronchoscopy locates sputum aspiration on lung function and inflammation response in patients with severe pneumonia. Method： A total of 74 patients with severe pneumonia from February 2018 to December 2019 in ICU of our hospital were selected. They were numbered according to the sequence of enrollment， and divided into control group and study group by odd and even numbers， 37 cases in each group. The two groups were treated with anti-infection therapy. The control group was treated with closed sputum suction tube suction sputum， the study group was treated with fiberoptic bronchoscope locate sputum aspiration. The efficacy was compared between two groups， and the APACHEⅡ score， compliance dynamic （Cdyn）， rapid shallow respiratory （RSB） and inflammatory response indexes were compared between the two groups before treatment and at the 7th day of treatment. Result： The total effective rate of treatment of the study group was higher than that of the control group （P<0.05）. On the 7th day of treatment， the APACHEⅡ score in both groups were lower than before treatment （P<0.05）， and those of study group were lower than those of the control group （P<0.05）; Cdyn and RSB in both groups were better than before treatment （P<0.05）， and that of study group was better than that of control group （P<0.05）; the levels of IL-6， TNF-α， IL-10 and PCT in both groups were lower than those before treatment （P<0.05）， and those of the study group were lower than those of the control group （P<0.05）. Conclusion： Anti-infection combined with fiberoptic bronchoscopy locates sputum aspiration can effectively improve the lung function of patients with severe pneumonia， reduce the inflammatory response， and improve the curative efficacy.

[Key words] Anti-infection Fiberoptic bronchoscopy locates sputum aspiration Severe pneumonia Lung function Inflammatory response

First-authors address： Xinhui District Peoples Hospital of Jiangmen City， Jiangmen 529100， China

doi：10.3969/j.issn.1674-4985.2021.13.031

重症肺炎是呼吸内科常见的危重症疾病，肺部炎症病灶是其重要特征，可堵塞气道，阻碍患者自主排痰，引起肺组织中的炎性因子及黏液分泌物无法有效清除，有毒物质在机体内可诱发全身炎症反应（systemic inflammatory response syndrome，SIRS），导致脓毒症、感染性休克、多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS），甚至死亡[1]。文献[2-3]报道重症肺炎病死率约为15.8%～47.4%。抗感染是重症肺炎的重要治疗手段，通过抗生素清除体内炎症反应，改善临床症状。纤维支气管镜是一种检查兼治疗的工具，其通过光学反光镜让操作者在直视条件下清除病灶部位炎性分泌物及痰液，解除气道梗阻，缓解气道压力，减轻呼吸肌做功，改善氧合状况。本文分析了抗感染联合纤维支气管镜定位吸痰在重症肺炎的应用效果，现报道如下。

1 资料与方法

1.1 一般资料 选取本院2018年2月-2019年12月74例ICU接收的重症肺炎患者。……