作者：李亚明，张进召，潘双

单位：

710077 陕西省西安市，西安医学院第一附属医院呼吸与危重症医学科；通信作者：张进召，E-mail：zhangjinzhao2006@sina.com

Units：

Department of Pulmonary and Critical Care Medicine，the First Affiliated Hospital of Xi'an Medical University，Xi'an710077，China；Corresponding author：ZHANG Jinzhao，E-mail：zhangjinzhao2006@sina.com

关键词：

呼吸机相关性肺炎；支气管肺泡灌洗；振动排痰；治疗结果；呼吸功能；血气分析

Keywords：

Ventilator-associated pneumonia；Bronchoalveolar lavage；Vibratory sputum discarding；treatmentoutcome；Respiratory function；Blood gas analysis

CLC：

R 639

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.14

Funds：

摘要：

目的　探讨纤维支气管镜肺泡灌洗诊疗术联合振动排痰对呼吸机相关性肺炎（VAP）患者的影响。方法　选取 2018 年 3 月—2019 年 3 月西安医学院第一附属医院 ICU 收治的 VAP 患者 88 例，采用随机数字表法分为对照组和观察组，每组 44 例。在常规治疗基础上，对照组患者给予纤维支气管镜肺泡灌洗诊疗术治疗，观察组患者在对照组治疗基础上给予振动排痰治疗；两组患者均持续治疗 1 周。比较两组患者临床疗效、机械通气时间、抗菌药物应用时间、ICU入住时间，治疗前后呼吸功能指标〔包括气道峰值吸气压力（PIP）、气道阻力（RAW）、呼吸做功（WOB）、动态肺顺应性（CLdyn）〕、动脉血气分析指标〔包括动脉血氧分压（PaO 2 ）、动脉血氧饱和度（SaO 2 ）、氧合指数（OI）、动脉血二氧化碳分压（PaCO 2 ）〕，并观察两组患者治疗期间不良反应发生情况。结果　（1）观察组患者临床疗效优于对照组（P<0.05）。（2）与对照组比较，观察组患者机械通气时间、抗菌药物应用时间、ICU入住时间缩短（P<0.05）。（3）观察组患者治疗前 PIP、RAW、WOB、CLdyn 与对照组相似，差异无统计学意义（P>0.05）；与对照组比较，观察组患者治疗后 PIP、RAW、WOB 降低，CLdyn 升高（P<0.05）。（4）观察组患者治疗前 PaO 2 、SaO 2 、OI、PaCO 2 与对照组相似，差异无统计学意义（P>0.05）；与对照组比较，观察组患者治疗后PaO 2 、SaO 2 、OI升高，PaCO 2 降低（P<0.05）。 （5）治疗期间两组患者不良反应发生率比较，差异无统计学意义（P>0.05）。结论　纤维支气管镜肺泡灌洗诊疗术联合振动排痰治疗 VAP 患者的临床疗效确切，能有效缩短患者机械通气时间、抗菌药物应用时间及 ICU 入住时间，改善患者呼吸功能及缺氧状态，且安全性较高。

Abstract：

Objective　To investigate the impact of fibrobronchoscopic alveolar lavage combined with vibratorysputum discarding on patients with ventilator-associated pneumonia（VAP）. Methods　From March 2018 to March 2019，a total of 88 patients with VAP were selected in ICU，the First Affiliated Hospital of Xi'an Medical University，and they weredivided into control group and observation group according to random number table method，with 44 cases in each group. Basedon conventional treatment，patients in control group received fibrobronchoscopic alveolar lavage，while patients in observationgroup received vibratory sputum discarding based on that of control group；both groups continuously treated for 1 week. Clinicaleffect，duration of mechanical ventilation and using antibiotics，ICU stays，as well as index of respiratory function（includingPIP，RAW，WOB and CLdyn）and arterial blood-gas analysis results（including PaO 2 ，SaO 2 ，OI and PaCO 2 ）before andafter treatment were compared between the two groups，moreover incidence of adverse reactions was observed during treatmentbetween the two groups. Results　（1）Clinical effect in observation group was statistically significantly better than that incontrol group（P<0.05）.（2）Compared with those in control group，observation group showed statistically significantlyshorter duration of mechanical ventilation and using antibiotics，and ICU stays（P<0.05）.（3）Compared with those in controlgroup，observation group showed similar PIP，RAW，WOB and CLdyn before treatment（P>0.05），while statisticallysignificantly lower PIP，RAW and WOB，but higher CLdyn after treatment（P<0.05）.（4）Compared with those in controlgroup，while observation group showed similar PaO 2 ，SaO 2 ，OI and PaCO 2 before treatment（P>0.05），while statisticallysignificantly higher PaO 2 ，SaO 2 and OI，but lower PaCO 2 after treatment（P<0.05）.（5）No statistically significantdifference of incidence of adverse reactions was found between the two groups during treatment（P>0.05）. ConclusionFibrobronchoscopic alveolar lavage combined with vibratory sputum discarding has certain clinical effect and relatively high safetyin treating patients with VAP，which can effectively shorten the duration of mechanical ventilation and using antibiotics as wellas ICU stays，improve the respiratory function and relieve the anoxia.

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