支气管肺泡灌洗复合低分子肝素对重症肺炎患者的影响OACSTPCD
The Effect of Bronchoalveolar Lavage Combined with Low Molecular Weight Heparin on Patients with Severe Pneumonia
目的 分析支气管肺泡灌洗复合低分子肝素对重症肺炎俯卧位通气患者病情转归的影响.方法 选择 2021 年 1 月至 2023 年 1 月自贡市第一人民医院 102 例重症肺炎患者为研究对象,按随机数表法分为对照组(n=51,常规治疗+低分子肝素)与研究组(n=51,常规治疗+低分子肝素+支气管肺泡灌洗).对比 2组治疗前、治疗 1 周时血气指标[血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]、呼吸动力学指标[呼吸做功(WOB)、气道阻力(Raw)、动态顺应性(Cdyn)]、肺功能指标[用力肺活量(FVC)、第 1 秒最大呼气容积(FEV1)、最高呼气流速(PEF)]、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)]及D-二聚体水平,统计2 组不良预后(死亡、入住ICU、插管+有创呼吸机)发生率.结果 治疗 1 周后,研究组SaO2、PaO2 水平比对照组高,PaCO2 比对照组低(t=4.649、3.774、4.792,P<0.05);治疗 1 周后,研究组WOB、Raw比对照组低,Cdyn比对照组高(t=7.207、5.401、3.150,P<0.05);治疗 1 周后,研究组FVC、FEV1、PEF比对照组高(t=3.834、3.960、3.908,P<0.05);治疗 1 周后,研究组TNF-α、IL-6、IL-8、D-二聚体水平比对照组低(t=5.642、5.002、6.712、4.127,P<0.05);研究组不良预后发生率比对照组低(χ2=4.547,P<0.05).结论 支气管肺泡灌洗复合低分子肝素可缩短重症肺炎俯卧位通气患者临床症状消失时间及住院时间,改善血气指标、呼吸动力学,提升肺功能,降低炎症因子水平,从而促进病情转归.
Objective To analyze the effect of bronchoalveolar lavage combined with low molecular weight heparin on the prognosis with prone ventilation due severe pneumonia.Methods 102 patients with the severe pneumonia from hospitals from January 2021 to January 2023 were selected as the study subjects and randomly divided into a control group(51 cases,conventional treatment+low molecular weight heparin)and a study group(51 cases,conventional treatment+low molecular weight heparin+bronchoalveolar lavage)using a random number table method.Blood gas indexes[blood oxygen saturation(SaO2),partial arterial oxygen pressure(PaO2),partial arterial carbon dioxide pressure(PaCO2)],respiratory dynamics indexes[respiratory work done(WOB),airway resistance(Raw),dynamic compliance(Cdyn)],pulmonary function indexes[forced vital capacity(FVC),1 second maximum expiratory volume(FEV1),maximum expiratory flow rate(PEF)],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)],and D-dimer levels before and the first week of treatment were compared between the two groups.And the incidence of adverse prognosis(death,ICU admission,intubation and invasive ventilator)was calculated in the two groups.Results After one week of the treatment,the levels of SaO2 and PaO2 in the study group were higher than those in the control group,while PaCO2 was lower than those in the control group(t=4.649,3.774,4.792,P<0.05);After one week of the treatment,the WOB and Raw levels in the study group were lower than those in the control group,while the Cdyn levels were higher than those in the control group(t=7.207,5.401,3.150,P<0.05);After one week of the treatment,the FVC,FEV1,and PEF in the study group were higher than those in the control group(t=3.834,3.960,3.908,P<0.05);After one week of the treatment,the study group had TNF-α、The levels of IL-6,IL-8,and D-dimer in the control group were lower than those in the control group(t=5.642、5.002、6.712、4.127,P<0.05);The incidence of poor prognosis in the study group was lower than that in the control group(χ2=4.547,P<0.05).Conclusion Bronchoalveolar lavage,combined with low molecular weight heparin,can shorten the duration of clinical symptom disappearance and hospital stay,improve the blood gas indexes,respiratory dynamics,enhance lung function and reduce the level of inflammatory factors in patients with severe pneumonia.
曾阳;王茜;田茂良
自贡市第一人民医院呼吸与危重症医学科,四川 自贡 643000自贡市第一人民医院健康管理科,四川 自贡 643000
临床医学
重症肺炎俯卧位通气支气管肺泡灌洗低分子肝素病情转归
Severe pneumoniaProne position ventilationBronchoalveolar lavageLow molecular weight heparinDisease outcome
《昆明医科大学学报》 2024 (005)
151-156 / 6
四川医学科研计划基金资助项目(S19046)
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