吸入性乙酰半胱氨酸肺泡灌洗对重症肺炎患者治疗效果观察

doi:10.3969/j.issn.1006-7795.2021.06.008

摘要/Abstract

摘要： 目的观察吸入性乙酰半胱氨酸肺泡灌洗治疗重症肺炎的治疗效果。方法 60例重症肺炎患者按照组间基线特征匹配的原则分为观察组和对照组,均给予呼吸机、抗感染、化痰等基础治疗及气管镜肺泡灌洗,灌洗液观察组为吸入性乙酰半胱氨酸盐溶液,对照组为0.9%(质量分数)氯化钠注射液,观察并比较两组患者治疗前后的白细胞、C反应蛋白、降钙素原、氧合指数、治疗有效率、机械通气时间、重症监护室(intensive care unit, ICU)留住时间,以及呼吸力学指标,如气道阻力、平台压、呼气末正压、肺动态顺应性等。结果治疗前,两组患者白细胞、C反应蛋白、降钙素原、氧合指数及呼吸力学指标比较,差异无统计学意义(P＞0.05)。治疗后,观察组白细胞、C反应蛋白、降钙素原、气道阻力、平台压、呼气末正压低于对照组;氧合指数、肺动态顺应性及治疗有效率观察组高于对照组;观察组机械通气时间及ICU留住时间小于对照组;组间比较,差异均有统计学意义(P＜0.05)。结论吸入性乙酰半胱氨酸进行肺泡灌洗可能有利于重症肺炎患者炎性反应吸收,改善预后。

关键词: 乙酰半胱氨酸, 支气管镜肺泡灌洗, 重症肺炎

Abstract: Objective To observe the therapeutic effect of inhaled acetylcysteine in the bronchoalveolar lavage treatment for the patients with severe pneumonia. Methods Sixty patients with severe pneumonia were randomly divided into the treatment and control groups according to the principle of baseline feature matching. All patients were given basic treatment such as mechanical ventilation, anti-infection, expectorant, and tracheoscopic bronchoalveolar lavage. The lavage fluid in the treatment group was inhaled acetylcysteine,and normal saline in the control group. The white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), oxygenation index (OI), respiratory mechanical indexes such as airway resistance (Raw), platform pressure (Pplat), positive end-expiratory pressure (PEEP), and dynamic lung compliance(Cdyn) were detected for the two groups before and after treatment. Moreover, treatment effective rate, mechanical ventilation time, and intensive care unit (ICU) retention time were compared with each other between the two groups. Results Before treatment: there were no significant differences in WBC, CRP, PCT, OI and respiratory mechanics indexes between the two groups (P>0.05). After treatment, WBC, CRP, PCT, RAW, PPLAT and PEEP in the treatment group were significantly decreased compared with that in the control group (P<0.05).OI, Cdyn and effective rate in the treatment group were higher than those in the control group (P<0.05).The mechanical ventilation time and ICU retention time in the treatment group were shorter than that in the control group (P<0.05), and the differences were statistically significant. Conclusion The bronchoalveolar lavage with inhaled acetylcysteine may benefit inflammatory absorption and improve prognosis in patients with severe pneumonia.

Key words: acetylcysteine, bronchoalveolar lavage, severe pneumonia

中图分类号:

R563.1

牛侠, 陈秀梅, 郑艳会. 吸入性乙酰半胱氨酸肺泡灌洗对重症肺炎患者治疗效果观察[J]. 首都医科大学学报, 2021, 42(6): 950-955.

Niu Xia, Chen Xiumei, Zheng Yanhui. Effect of inhaled acetylcysteine alveolar lavage therapy on patients with severe pneumonia[J]. Journal of Capital Medical University, 2021, 42(6): 950-955.

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