早期连续支气管灌洗在老年昏迷病人肺部感染中的防治作用

doi:10.3969/j.issn.1003-9198.2021.02.006

摘要/Abstract

摘要： 目的探讨早期连续支气管灌洗对老年昏迷病人肺部感染的防治作用。方法选取2016～2019年我科住院老年昏迷病人95例。根据我科分别开展常规支气管灌洗和早期支气管灌洗的时间顺序分组:入院48 h内无肺部感染征象即开始每日行支气管灌洗的28例为早期灌洗组;其余67例为非早期灌洗组。非早期灌洗组中诊断肺部感染后间断行支气管灌洗的25例为常规灌洗组,未灌洗的42例为未灌洗组。各组均行吸痰管吸痰、体外震动排痰、雾化、抗感染等防治措施。比较各组肺部感染的发生及控制情况;比较治疗后各组肺通气功能和炎症反应程度以及分泌物细菌计数的差异。结果早期灌洗组较常规灌洗组和未灌洗组肺部感染发生时间推迟,治疗第1、3、7天临床肺部感染评分量表(clinical pulmonary infection score,CPIS)评分、平均抗菌素DDD值及感染控制时间均降低(P＜0.05)。早期灌洗组的PaCO₂低于常规灌洗组和未灌洗组,PaO₂高于常规灌洗组和未灌洗组,血浆TNF-α、IL-6水平均低于常规灌洗组和未灌洗组(P＜0.05)。治疗第3天,早期灌洗组的CRP、PCT水平及分泌物细菌计数显著低于常规灌洗组和未灌洗组(P＜0.05)。结论早期连续支气管灌洗能降低昏迷病人肺部感染的严重程度,缩短感染控制时间,其作用机制可能与抑制炎症反应程度和降低细菌数量有关。

关键词: 早期支气管灌洗, 老年人, 昏迷, 肺部感染

Abstract: Objective To investigate the effect of early continuous bronchial lavage on pulmonary infection in senile comatose patients. Methods A total of 95 elderly comatose inpatients were selected from January 2016 to December 2019. The patients were divided into two groups according to the time sequence of routine and early bronchial lavage. The early lavage group consisted of 28 patients receiving early lavage who had no signs of pulmonary infection within 48 hours after admission. The other 67 were non-early lavage group. In the non-early lavage group, 25 patients who underwent intermittent bronchial lavage after diagnosis of pulmonary infection were lavage group, and 42 patients without lavage were non lavage group. All the groups were treated with aspiration of sputum, extracorporeal vibration expectoration, atomization, anti-infection and other preventive measures. Occurrence and control of pulmonary infection, pulmonary ventilation function and inflammatory response after treatment, bacterial count of secretion were compared among the three groups. Results The occurrence time of pulmonary infection in early lavage group was longer, CPIS value on the 1st, 3rd and 7th day after treatment, average antibiotic DDD value and infection control time were decreased than those in lavage group and non lavage group (P<0. 05); After pulmonary infection, arterial partical pressure of carbon dioxide, plasma concentrations of tumor necrosis factor-α and interleukin-6 were lower and arterial partial pressure of oxygen was higher in early lavage group than those in lavage group and non lavage group (P<0. 05); The third day, the bacterial count of secretion and the levels of C-reactive protein and procalcitonin in early lavage group were lower than those in lavage group and non lavage group (P<0. 05). Conclusions Early continuous bronchial lavage can reduce the severity of pulmonary infection in comatose patients and shorten the infection control time, which may be related to the inhibition of inflammatory response and the reduction of bacterial count.

Key words: early continuous bronchial lavage, aged, coma, lung infection

中图分类号:

R 563.1

姜道明, 滕晓华, 杨彬, 王光华. 早期连续支气管灌洗在老年昏迷病人肺部感染中的防治作用[J]. 实用老年医学, 2021, 35(2): 132-136.

JIANG Dao-ming, TENG Xiao-hua, YANG Bin, WANG Guang-hua. Prevention and treatment of pulmonary infection in elderly comatose patients by early continuousbronchial lavage[J]. Practical Geriatrics, 2021, 35(2): 132-136.

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