纤维支气管镜下沐舒坦肺泡灌洗对重症脑卒中患者肺部感染的疗效

Effect of mucosolvan bronchoalveolar lavage on stroke patients with pulmonary infection

摘要:

目的观察纤维支气管镜(纤支镜)下沐舒坦肺泡灌洗对重症脑卒中患者肺部感染的治疗效果。方法 选择重症脑卒中合并肺部感染可行纤支镜肺泡灌洗的患者42例，随机分为生理盐水组与沐舒坦组各21例。全部患者入重症监护室（ICU）后进行经验性抗感染、扩张支气管、雾化吸入及静脉滴注沐舒坦等治疗。记录患者开始治疗前APACHEⅡ评分、GCS评分、C反应蛋白（CRP）、 临床肺部感染评分（CPIS），比较2组肺泡灌洗次数、每次肺泡灌洗时间、吸出痰液量、住ICU天数、使用呼吸机时间及灌洗前后CPIS分值。结果2组患者年龄、性别、开始肺泡灌洗前的GCS评分、APACHEⅡ评分、CRP值比较,差异无统计学意义(P＞0.05)。沐舒坦组与生理盐水组肺泡灌洗次数、平均每次灌洗时间和灌洗痰液量比较，差异无统计学意义（P=0.05）；沐舒坦组使用呼吸机时间(63.57±21.94) h及住ICU时间(6.24±1.04) d少于生理盐水组［分别为（88.24±21.35）h和（7.95±1.36）d］，差异有统计学意义（分别t=-3.69，P=0.00；t=-4.58，P=0.00）。灌洗后第3、4天，沐舒坦组CPIS分值（分别为2.36±0.77、2.17±0.81）较生理盐水组（分别为4.16±0.86、3.54±1.09）低,且差异有统计学意义（分别t=3.60，P=0.00；t=2.25，P=0.03）。结论纤支镜下沐舒坦肺泡灌洗能促进脑卒中患者肺部感染的康复。

Abstract:

ObjectiveTo evaluate the effect of mucosolvan bronchoalveolar lavage  on stroke patients with pulmonary infection.MethodsFortytwo stroke patients with pulmonary infection were randomly divided into two groups, normal saline group and mucosolvan group were 21 cases respectively. All  patients were treated with antiinfection, bronchodilatation, aerosol inhalation and intravenous drip of mucosolvan in ICU. Observed indicators included acute physiological and chronic health evaluation (APACHE Ⅱ ) score, Glasgow coma scale (GCS) ,Creaction protein (CPR), and clinic pulmonary infection score (CPIS) in all cases. The number of alveolar lavage ,the average duration of lavage,  aspirated sputum volume, the days in ICU , duration of using ventilators and CPIS were compared before and after lavage between two groups.ResultsThere were no significant difference in age, gender, GCS score, APPACHE Ⅱ score and CRP before lavation in both groups(P>0.05), and there was also no  statistical difference in lavage number, average duration of lavage, and aspirated sputum volume between two groups (P=0.05); mucosolvan group had less time on the ventilator ( ［63.57±21.94］h )and less  day to stay in ICU(［6.24±1.04］d) than saline group（［88.24±21.35］h, ［7.95±1.36］d ,respectively）(t=-3.69,P=0.00;t=-4.58,P=0.00) ; at the 3rd  and 4th day after lavage ,  CPIS in mucosolvan group was (2.36±0.77) and ( 2.17±0.81) respectively, which were significantly lower than saline group(［4.16±0.86］,［3.54±1.09］, respectively)(t=3.60,P=0.00;t=2.25,P=0.03).ConclusionMucosolvan bronchoalveolar lavage can promote stroke patients to  recover from pulmonary  infection.