黄小霞 刘红兵

[摘要]目的探讨纤支镜肺泡灌洗联合物理排痰治疗吸入性肺炎患者的治疗效果及安全性。方法选取2019年1月至2020年12月在云浮市人民医院就诊的114例吸入性肺炎患者作为研究对象，按照随机数字表法将其分为对照组（ n=57）和观察组（ n=57）。对照组患者采取纤支镜肺泡灌洗治疗，观察组患者在对照组治疗的基础上联合物理排痰，治疗1周。记录两组患者治疗前及治疗1周后的血气分析指标及脉搏血氧饱和度、炎症指标、临床肺部感染评分（CPIS）、临床疗效及不良反应。结果治疗后两组患者的动脉血氧分压（PaO2）及脉搏血氧饱和度（SpO2）较治疗前升高，动脉血二氧化碳分压（PaCO2）较治疗前降低，且观察组均优于对照组，差异均有统计学意义（P <0.001）;治疗后两组患者的白细胞计数（WBC）、降钙素原（PCT）、 C 反应蛋白（CRP）及 CPIS 分值較治疗前降低，且观察组低于对照组，差异有统计学意义（ P <0.05）;治疗后观察组的临床总有效率（87.72%）显著高于对照组（71.93%），差异有统计学意义（P <0.05），两组患者治疗期间无严重不良反应。结论通过纤支镜肺泡灌洗联合物理排痰治疗，可显著改善吸入性肺炎患者的呼吸功能，降低炎症反应，提高治疗有效率。

[关键词]纤支镜肺泡灌洗;物理排痰;吸入性肺炎;体位引流

[中图分类号] R563.1  [文献标识码] A   [文章编号]2095-0616（2021）24-0214-04

Observation on the effect of bronchoalveolar lavage under fiberoptic bronchoscope combined with physical expectoration in the treatment of patients with aspiration pneumonia

HUANG  Xiaoxia    LIU  Hongbing

Department of General Medicine， Yunfu People's Hospital， Guangdong， Yunfu 527300， China

[Abstract] Objective To explore the therapeutic effect and safety of bronchoalveolar lavage （BAL） under fiberoptic bronchoscope combined with physical expectoration on patients with aspiration pneumonia （AP）. Methods A total of 114 AP patients treated in Yunfu People' Hospital from January 2019 to December 2020 were selected as research objects， and they were divided into the control group （n =57） and the observation group （n=57） according to random number table method. Patients in the control group were treated with BAL under fiberoptic bronchoscope for one week， while patients in the observation group were treated with physical expectoration on the basis of the treatment in the control group for one week. Blood gas analysis indexes， pulse oxygen saturation， inflammation indexes， clinical pulmonary infection score （CPIS）， clinical efficacy and adverse reactions of two groups were recorded before and one week after treatment. Results After treatment， the partial pressure of oxygen （PaO2） and the saturation of pulse oxygen （SpO2） of the two groups were higher than those before treatment， while the partial pressure of carbon dioxide （PaCO2） was lower than that before treatment， and the observation group was superior to the control group， with statistically significant differences （P <0.001）. After treatment， the scores of white blood cell count （WBC）， procalcitonin （PCT）， C-reactive protein （CRP） and Clinical Pulmonary Infection Score （CPIS） in the two groups were lower than those before treatment， and the observation group was lower than the control group， with statistically significant difference （P <0.05）. After treatment， the total clinical effective rate of the observation group （87.72%） was significantly higher than that of the control group （71.93%）， with statistically significant difference （P <0.05）. There were no serious adverse reactions in the two groups during treatment. Conclusion BAL under fiberoptic bronchoscope combined with physical expectoration can significantly improve the respiratory function of AP patients， reduce inflammatory reaction and improve the effective rate of treatment.

[Key words] Bronchoalveolar lavage; Physical expectoration; Aspiration pneumonia; Postural drainage

吸入性肺炎是指患者存在误吸风险，吸入食物、口鼻咽部分泌物或反流的胃内容物进入下呼吸道所引起的肺部化学性炎症或合并细菌性炎症[1]。吸入性肺炎患者病死率高达24.6%～50%[2-3]。随着医疗技术的发展，纤支镜肺泡灌洗成为减少患者气道分泌物的方法之一。另外促排痰的方法还有物理排痰，包括加强气道湿化、有效咳嗽、体位引流、拍背及胸壁震荡[4]。本研究通过纤支镜肺泡灌洗联合物理排痰治疗吸入性肺炎患者，对其效果及安全性进行探究。现报道如下。

1资料与方法

1.1一般资料

选取2019年1月至2020年12月在云浮市人民医院（我院）就诊的114例诊断为吸入性肺炎患者。……