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目的观察床旁纤维支气管镜吸痰及肺泡灌洗在卒中相关性肺炎患者中的应用价值及安全性。方法将139例卒中相关性肺炎患者随机分为常规组(69例)和纤维支气管镜治疗组(70例)。常规组采用普通吸痰管吸痰及抗生素等常规治疗;纤维支气管镜治疗组在常规治疗的同时采用纤维支气管镜吸痰及肺泡灌洗。动态观察患者体温、血常规、胸片及气管分泌物,用简化临床肺部感染评分(CPIS)对患者进行肺部感染评分。比较两组患者治疗前后临床肺部感染评分、使用抗生素时间,每天吸痰次数、住院天数,病死率及检查不良反应发生率。结果纤维支气管镜治疗组冶疗前后临床肺部感染评分(CPIS)比较、住院天数、使用抗生素时间、每天吸痰次数等指标均优于常规组(P﹤0.05)。纤维支气管镜检查不良反应少。结论在加强抗感染的基础上进行纤维支气管镜吸痰及肺泡灌洗是治疗卒中相关性肺炎的一种有效、安全的辅助治疗措施,具有很高的临床应用价值,值得推广应用。
Objective To observe the value and safety of bedside fiberoptic bronchoscopy suction and alveolar lavage in patients with stroke-associated pneumonia. Methods One hundred and ninety-nine patients with stroke-associated pneumonia were randomly divided into routine group (69 cases) and fibroscopic bronchoscopy group (70 cases). The conventional group was treated by ordinary suctioning tube and sputum aspiration and antibiotics and so on. The patients in the group treated by fiberoptic bronchoscopy were treated by bronchoscopy and bronchoalveolar lavage simultaneously. Patients’ body temperature, blood routine, chest radiographs and tracheal secretions were dynamically observed. The patient’s lung infection score was scored using a simplified clinical lung infection score (CPIS). The clinical lung infection scores, antibiotic time, number of sputum aspiration, days of hospitalization, mortality and incidence of adverse reactions were compared between the two groups before and after treatment. Results Before and after treatment, the clinical pulmonary infection score (CPIS), length of hospital stay, time of using antibiotics and number of sputum aspiration per day were all better than those of the conventional group (P <0.05). Fiber bronchoscopy adverse reactions less. Conclusion It is an effective and safe adjuvant therapy for the treatment of stroke-associated pneumonia with bronchoscopy and sputum aspiration and bronchoalveolar lavage based on the enhancement of anti-infective. It is of great value in clinical application and should be popularized and applied.