刘立文 欧松利 关祝全 张莹茹

【摘要】 目的：探讨乙酰半胱氨酸溶液局部注入联合支气管肺泡灌洗治疗卒中相关性肺炎（SAP）的临床效果。方法：选择阳江市第三人民医院内一科2021年7月—2023年4月收治的SAP患者100例，采用随机数字表法分为观察组与对照组，各50例。对照组予抗感染、经纤维支气管镜吸痰和肺泡灌洗治疗，观察组在对照组基础上联合乙酰半胱氨酸溶液局部注入治疗。比较两组临床疗效、治疗前后血清炎症因子水平与呼吸功能，观察两组治疗过程中发生的不良反应和并發症。结果：观察组治疗总有效率（96.00%）高于对照组（78.00%），差异有统计学意义（P<0.05）。两组治疗前C反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因子-α（TNF-α）水平比较，差异均无统计学意义（P>0.05）；治疗后两组血清炎症因子水平均有所下降，观察组CRP、PCT、TNF-α水平均低于对照组（P<0.05）。两组治疗前氧合指数（OI）、气道阻力（Raw）、动脉血二氧化碳分压（PaCO2）比较，差异均无统计学意义（P>0.05）；治疗后两组OI均高于治疗前，Raw、PaCO2均低于治疗前，观察组OI高于对照组，Raw、PaCO2均低于对照组（P<0.05）。两组均未发生治疗相关不良反应和并发症。结论：乙酰半胱氨酸溶液局部注入联合支气管肺泡灌洗治疗SAP效果显著，能够有效下调患者血清炎症因子水平，改善呼吸功能，安全性高。

【关键词】 卒中相关性肺炎 纤维支气管镜 乙酰半胱氨酸溶液 炎症因子 呼吸功能

Clinical Study of Acetylcysteine Solution Local Injection Combined with Bronchoalveolar Lavage in the Treatment of Stroke Associated Pneumonia/LIU Liwen， OU Songli， GUAN Zhuquan， ZHANG Yingru. //Medical Innovation of China， 2024， 21（07）： 0-075

[Abstract] Objective： To investigate the clinical effect of Acetylcysteine Solution local injection combined with bronchoalveolar lavage in the treatment of stroke associated pneumonia （SAP）. Method： A total of 100 SAP patients admitted to the Third People's Hospital of Yangjiang City from July 2021 to April 2023 were selected and divided into observation group and control group according to random number table method， with 50 cases in each group. The control group was treated with anti-infection， sputum suctioning via flexible bronchoscope and bronchoalveolar lavage， and the observation group was treated with Acetylcysteine Solution local injection on the basis of control group. The clinical efficacy， before and after treatment of serum inflammatory factors levels and respiratory function were compared between the two groups， and the adverse reactions and complications occurred in the course of treatment between the two groups were observed. Result： The total effective rate of the observation group （96.00%） was higher than that of the control group （78.00%）， the difference was statistically significant （P<0.05）. Before treatment， there were no significant differences in the levels of C reactive protein （CRP）， procalcitonin （PCT） and tumor necrosis factor-α （TNF-α） between the two groups before treatment （P>0.05）. After treatment， the levels of serum inflammatory factors were decreased in both groups， and the levels of CRP， PCT and TNF-α in observation group were lower than those in control group （P<0.05）. Before treatment， there were no significant differences in oxygenation index （OI）， airway resistance （Raw） and arterial partial pressure of carbon dioxide （PaCO2） between the two groups before treatment （P>0.05）. After treatment， OI in both groups were higher than those before treatment， Raw and PaCO2 were lower than those before treatment， OI in observation group was higher than that in control group， Raw and PaCO2 in observation group were lower than those control group （P<0.05）. There were no treatment-related adverse reactions and complications in the two groups. Conclusion： Acetylcysteine Solution local injection combined with bronchoalveolar lavage in the treatment of SAP is effective， can effectively reduce the level of serum inflammatory factors， improve respiratory function， and high safety.

[Key words] Stroke associated pneumonia Flexible bronchoscope Acetylcysteine Solution Inflammatory factors Respiratory function

First-author's address： Department of Internal Medicine Ⅰ， the Third People's Hospital of Yangjiang City， Yangjiang 529500， China

doi：10.3969/j.issn.1674-4985.2024.07.017

我国每年脑卒中的新发病例超过200万，虽然从20世纪90年代开始全球脑卒中的发病率与死亡率都有所下降，但我国依然保持上升的发展趋势，有沉重的疾病负担[1-2]。脑卒中易合并多类并发症，卒中相关性肺炎（stroke associated pneumonia，SAP）是最危险的并发症之一[3]，当前临床主要治疗措施为吸痰、抗感染治疗、化痰平喘等，但整体疗效欠佳[4]。临床报道显示，支气管肺泡灌洗能有效清除气道内浓痰及炎症分泌物[5]，但对于塑形性支气管炎与分泌物较为黏稠的患者，单纯采用支气管肺泡灌洗的效果难以达到预期，甚至多次灌洗也无法有效去除痰栓与分泌物[6]。……