标题：机械振动排痰联合纤维支气管镜治疗重症肺炎疗效观察

      作者：程添长，梁伟杏，邓梓铭，徐永乐    肇庆市高要区人民医院重症医学科，广东 肇庆 526040

      卷次： 2020年31卷15期

      【摘要】 目的 探讨机械振动排痰联合纤维支气管镜治疗重症肺炎的临床疗效。方法 选择2017年10月至2019年10月期间高要区人民医院重症医学科收治的82例重症肺炎患者为研究对象，根据随机数表法将患者分为观察组42例和对照组40例。所有患者均合并呼吸衰竭且接受机械通气治疗，对照组采用纤维支气管镜肺泡灌洗治疗，观察组在纤支镜治疗前先应用振动排痰治疗。比较两组患者的临床疗效、治疗前及治疗后 2 h的氧合指数(PaO2/FiO2)，呼吸做功(WOB)和动态顺应性(Cydn)，同时比较两组患者的机械通气时间、住 ICU时间、28 d死亡率。结果 治疗后，观察组患者的PaO2/FiO2、Cdyn水平分别为382.47±60.42、(38.43±4.50) mL/cmH2O，明显高于对照组的351.37±44.31、(31.82±8.64) mL/cmH2O，WOB水平为(0.67±0.24) J/L，明显低于对照组的(0.95±0.36) J/L，差异均有统计学意义(P<0.05)；观察组患者的机械通气时间和住 ICU时间分别为(6.07±1.12) d、(7.96±2.38) d，明显少于对照组的(8.46±2.25) d、(11.85±3.67) d，差异均有统计学意义(P<0.05)；观察组和对照组患者住院 28 d死亡率分别为4.76%和7.50%，差异无统计学意义(P>0.05)；观察组患者治疗总有效率为88.10%，明显高于对照组的72.50%，差异有统计学意义(P<0.05)。结论 机械振动排痰联合纤维支气管镜治疗重症肺炎，对患者肺泡氧合功能、呼吸功能功能的改善更加有利，可以缩短患者的病程，提高临床疗效。
      【关键词】 重症肺炎；呼吸衰竭；机械通气；振动排痰；肺泡灌洗；疗效
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2020）15—1958—03

Curative effect of mechanical vibration expectoration combined with fiberbronchoscope in the treatment ofsevere pneumonia.
CHENG Tian-chang, LIANG Wei-xing, DENG Zi-ming, XU Yong-le. Department of CriticalMedicine, Zhaoqing Gaoyao District People's Hospital, Zhaoqing 526040, Guangdong, CHINA
【Abstract】 Objective To investigate the clinical effect of mechanical vibration expectoration combined with fi-berbronchoscope in the treatment of severe pneumonia. Methods Eighty-two patients with severe pneumonia in Depart-ment of Critical Medicine, Zhaoqing Gaoyao District People's Hospital from October 2017 to September 2019 were se-lected as the study objects. According to the method of random number table, the patients were divided into two groups:observation group (42 cases) and control group (40 cases). All the patients were treated with respiratory failure and me-chanical ventilation. The control group was treated with bronchoalveolar lavage with fiberoptic bronchoscope, and the ob-servation group was treated with vibration expectoration before the treatment with fiberoptic bronchoscope. The clinical ef-fects, PaO2/FiO2, WOB, and Cdyn of the two groups were observed before and 2 hours after treatment. The mechanicalventilation time, ICU time, and 28-day mortality of the two groups were compared between the two groups. Results Af-ter treatment, the PaO2/FiO2 and Cdyn levels in the observation group were 382.47±60.42, (38.43±4.50) mL/cmH2O, sig-nificantly higher than 351.37±44.31, (31.82±8.64) mL/cmH2O in the control group, and the WOB level in the observa-tion group was (0.67±0.24) J/L, significantly lower than (0.95±0.36) J/L in the control group (P<0.05). Mechanical venti-lation time and ICU stay time in the observation group were (6.07±1.12) d and (7.96±2.38) d, which were significantlylower than (8.46±2.25) d and (11.85±3.67) d of the control group (P<0.05). The 28-day hospital mortality was 4.76% inthe observation group compared with 7.50% in the control group, and there was no significant difference (P>0.05). Thetotal effective rate of the observation group was 88.10% , which was significantly higher than 72.50% of the controlgroup (P<0.05). Conclusion Mechanical vibration expectoration combined with fiberbronchoscope is more beneficialto the improvement of pulmonary oxygenation and respiratory function in patients with severe pneumonia. It can shortenthe course of disease and improve the clinical effect.
      【Key words】 Severe pneumonia; Respiratory failure; Mechanical ventilation; Vibration expectoration; Alveolarlavage; Efficacy