2021 年第 4 期 第 16 卷

纤维支气管镜吸痰联合肺泡灌洗对高龄慢性阻塞性肺疾病合并重症肺炎患者的疗效观察

Curative efficacy of fiberoptic bronchoscopy for sputum suction combined with alveolar lavage on elderly patients with chronic obstructive pulmonary disease complicated with severe pneumonia 

作者：邓晓慧田巍葛晓竹岳睿原源

英文作者：Deng Xiaohui Tian Wei Ge Xiaozhu Yue Rui Yuan Yuan

单位：北京积水潭医院干部科100035

英文单位：Department of Cadre Beijing Jishuitan Hospital Beijing 100035 China

关键词：慢性阻塞性肺疾病；重症肺炎；纤维支气管镜；高龄

英文关键词：Chronicobstructivepulmonarydisease;Severepneumonia;Fiberopticbronchoscopy;Elderly

• 摘要：

• 目的 探讨纤维支气管镜吸痰联合肺泡灌洗对高龄慢性阻塞性肺疾病（COPD）合并重症肺炎患者的临床疗效。方法 回顾性分析北京积水潭医院2018年6月至2020年9月收治的62例高龄COPD合并重症肺炎患者的临床资料。其中行抗感染，雾化吸入，按需吸痰管吸痰，维持水、电解质、酸碱平衡及营养支持等常规对症治疗32例（对照组），在常规对症治疗基础上接受纤维支气管镜吸痰联合肺泡灌洗治疗30例（观察组）。比较2组治疗前和治疗5 d后血气分析指标［动脉血氧分压（PaO2）、氧合指数、动脉血二氧化碳分压(PaCO2)、乳酸］和炎症因子［白细胞计数（WBC）、C反应蛋白、降钙素原］水平，痰菌阳性率和临床疗效。结果 治疗前，2组动脉血气分析指标水平比较差异均无统计学意义（均P＞0.05）；治疗后2组PaO2均高于治疗前、且观察组高于对照组［(74±8)mmHg(1 mmHg=0.133 kPa)比（66±8）mmHg］，PaCO2和乳酸水平均低于治疗前、且观察组均低于对照组［(38±8)mmHg比（46±9）mmHg，(1.3±0.9)mmol/L比（1.9±1.1）mmol/L］；治疗后观察组氧合指数高于本组治疗前和对照组［(269±82)比（196±74）、（189±90）］（均P＜0.05）。治疗前，2组WBC、C反应蛋白和降钙素原水平比较差异均无统计学意义（均P＞0.05）；治疗后2组WBC和C反应蛋白水平均低于治疗前、且观察组均低于对照组，治疗后观察组降钙素原水平低于本组治疗前和对照组（均P＜0.05）。观察组痰菌阳性率和总有效率均高于对照组［93.3%(28/30）比59.4%（19/32），93.3%(28/30）比62.5%（20/32）］（均P＜0.05）。结论 纤维支气管镜吸痰联合肺泡灌洗治疗可有效改善高龄COPD合并重症肺炎患者氧合情况，减轻机体炎症反应，提高痰菌阳性率和疗效。

• Objective To investigate the clinical effect of fiberoptic bronchoscopy for sputum suction combined with alveolar lavage on elderly patients with chronic obstructive pulmonary disease (COPD) complicated with severe pneumonia. Methods The clinical data of 62 elderly patients of COPD complicated with severe pneumonia admitted to Beijing Jishuitan Hospital from June 2018 to September 2020 were retrospectively analyzed. Among them, 32 cases were treated with conventional symptomatic treatment, such as anti infection, atomization inhalation, suction pipe sputum aspiration on demand, and maintenance of water, electrolyte, acid-base balance and nutritional support (control group), and 30 cases were treated with fiberoptic bronchoscopy for sputum suction combined with alveolar lavage on the basis of conventional symptomatic treatment (observation group). Blood gas analysis indexes ［arterial partial pressure of oxygen (PaO2), oxygenation index, arterial partial pressure of carbon dioxide (PaCO2), lactic acid］ and inflammatory indexes ［white blood cell count (WBC), C-reactive protein (CRP), procalcitonin］ levels, sputum bacteria positive rate and clinical effect were compared between the two groups before and after treatment for 5 d. Results Before treatment, there was no significant difference in arterial blood gas analysis indexes between the two groups (all P＞0.05); after treatment, the levels of PaO2 in the two groups were higher than those before treatment, and that in observation group was higher than that in control group ［(74±8)mmHg vs (66±8)mmHg］, the levels of PaCO2 and lactic acid in the two groups were lower than those before treatment, and those in observation group was lower than those in control group ［(38±8)mmHg vs (46±9)mmHg, (1.3±0.9)mmol/L vs (1.9±1.1)mmol/L］; after treatment, the oxygenation index in observation group was higher than that before treatment and that in control group ［(269±82) vs (196±74), (189±90)］(all P＜0.05). Before treatment, there were no significant differences in the levels of WBC, CRP and procalcitonin between the two groups (all P＞0.05); after treatment, the levels of WBC and CRP in the two groups were lower than those before treatment, and those in observation group were lower than those in control group; the procalcitonin level in the observation group was lower than that before treatment and that in control group(all P＜0.05). The sputum bacteria positive rate and total effective rate in observation group were higher than those in control group［93.3%(28/30） vs 59.4%(19/32), 93.3%(28/30） vs 62.5%(20/32)］(all P＜0.05). Conclusion Fiberoptic bronchoscopy for sputum suction combined with alveolar lavage can effectively improve the oxygenation of elderly COPD patients complicated with severe pneumonia, reduce the inflammatory reaction, and improve the sputum bacteria positive rate and curative effect.