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目的:探讨规律纤维支气管镜吸痰对全肺切除术后心衰的治疗效果。方法:选取唐都医院胸外科于2012年1月至2014年1月行开胸全肺切除术,且术后并发心衰的患者184例进行前瞻性随机对照研究,将所选患者分为研究组(96例)和对照组(88例),前者除常规心衰治疗外,每天至少1次使用纤维支气管镜吸痰,必要时可根据痰量增加吸痰次数;后者仅采用利尿、强心、扩血管等常规疗法,比较两组患者的心指数、呼吸频率、动脉血气分析等指标,同时测定和比较两组患者治疗后72 h的血浆脑钠肽浓度。结果:治疗后1 h,对照组患者的心指数由(2.7±0.2)L/min·m2升高至(3.1±0.3)L/min·m2,呼吸频率由(35.4±2.9)次/分降至(21.3±2.5)次/分,Pa O2由(57.4±3.9)mm Hg升至(60.3±3.4)mm Hg,Sa O2由(83.5±7.1)%升至(86.3±3.7)%;研究组患者的心指数由(2.8±0.1)L/min·m2升高至(3.5±0.2)L/min·m2,呼吸频率由(34.2±3.1)次/分降至(19.2±2.2)次/分,Pa O2由(56.5±4.8)mm Hg升至(66.2±7.1)mm Hg,Sa O2由(84.5±6.5)%升至(91.6±3.5)%,差异具有统计学意义(P<0.05),研究组患者治疗后的以上指标水平均明显优于对照组(P<0.05)。治疗后24 h内,79.2%的研究组患者咳嗽、咳痰及肺部湿罗音基本缓解,对照组患者以上症状、体征的缓解率为47.7%,差异具有统计学意义(P<0.05)。治疗后72 h,研究组患者的血浆脑钠肽浓度显著低于对照组患者(576.3±77.6 vs894.6±86.5,P<0.01)。结论:支气管镜吸痰有助于改善全肺切除术后心衰患者的心肺功能。
Objective: To investigate the therapeutic effect of regular fiberoptic bronchoscopy on sputum after pneumonectomy. Methods: A prospective randomized controlled trial of 184 patients with thoracic pneumonectomy undergoing thoracotomy and pneumoconiosis in Tangdu Hospital from January 2012 to January 2014 was selected. The selected patients were divided into two groups: study (96 cases) and control group (88 cases). The former was treated with fiberoptic bronchoscopy at least once a day except routine heart failure treatment, and the number of sputum ascending could be increased according to the amount of sputum as needed. The latter was only treated with diuretic and strong Heart and vasodilator. The cardiac index, respiration rate and arterial blood gas analysis were compared between the two groups. Plasma concentrations of brain natriuretic peptide at 72 hours after treatment were also measured and compared. Results: At 1 h after treatment, the heart index of the control group increased from (2.7 ± 0.2) L / min · m2 to (3.1 ± 0.3) L / min · m2 and the respiratory rate decreased from (35.4 ± 2.9) PaO2 increased from (57.4 ± 3.9) mmHg to (60.3 ± 3.4) mmHg, and Sa O2 increased from (83.5 ± 7.1)% to (86.3 ± 3.7)% to (21.3 ± 2.5) The patient’s heart index increased from (2.8 ± 0.1) L / min · m2 to (3.5 ± 0.2) L / min · m2, and the respiratory rate decreased from (34.2 ± 3.1) / minute to (19.2 ± 2.2) , Pa O2 increased from (56.5 ± 4.8) mmHg to (66.2 ± 7.1) mmHg, and Sa O2 increased from (84.5 ± 6.5)% to (91.6 ± 3.5)%, with statistical significance (P <0.05) The levels of the above indexes in the study group were significantly better than those in the control group (P <0.05). Within 24 hours after treatment, 79.2% of the patients in the study group were relieved of cough, expectoration and lung wet rales. The relief rate of the above symptoms and signs in the control group was 47.7%, the difference was statistically significant (P <0.05). At 72 hours after treatment, the concentration of plasma brain natriuretic peptide in study group was significantly lower than that in control group (576.3 ± 77.6 vs 894.6 ± 86.5, P <0.01). CONCLUSIONS: Bronchoscopy suctioning helps to improve cardiopulmonary function in patients with heart failure after pneumonectomy.