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目的探讨沐舒坦联合肺灌洗在重型颅脑损伤患者气管切开术后肺部感染的预防与治疗中的价值。方法将90例患者随机分为观察组和对照组,每组45例。对照组给予纤维支气管镜下肺灌洗,观察组给予沐舒坦联合纤维支气管镜下肺灌洗。比较两组患者气管切开术第1、3、5、7天支气管肺泡灌洗液细胞分类和计数,以及两组患者气管切开后30 d内气管套管拔除例数。记录两组患者气管切开30 d后肺部感染例数、控制例数、控制天数和二次感染病例。结果两组气管切开7 d后的白细胞数和多形核细胞数较第1天均明显减少(P<0.05)。观察组分别从第5天和第3天白细胞数和多形核细胞数显著低于对照组,差异有统计学意义(P<0.05)。观察组肺部感染率为66.67%(30/45),控制率为86.67%(26/30),与对照组比较差异有统计学意义(P<0.05)。气管切开30 d后,观察组和对照组气管套管拔除率分别为60.0%和26.7%,差异有统计学意义(P<0.05)。结论沐舒坦联合肺灌洗可以有效预防重型颅脑损伤患者气管切开术后肺部感染的发生,并能更好地控制肺部感染,促进气管修复,具有良好的临床疗效,值得在实践中推广使用。
Objective To investigate the value of mucosolvan combined with lung lavage in the prevention and treatment of pulmonary infection after tracheotomy in patients with severe craniocerebral injury. Methods 90 patients were randomly divided into observation group and control group, 45 cases in each group. The control group was given bronchoalveolar lavage and the observation group was given mucosolvan combined with bronchoscopic lung lavage. The cell sorting and counting of bronchoalveolar lavage fluid were compared on the 1st, 3rd, 5th and 7th days of tracheotomy in both groups, and the number of tracheal cannula was removed within 30 days after tracheotomy in both groups. The number of cases of pulmonary infection, control cases, days of control and secondary infection were recorded after 30 days of tracheotomy in both groups. Results The numbers of leukocytes and polymorphonuclear cells in both groups after tracheotomy for 7 days were significantly lower than those on the first day (P <0.05). The number of white blood cells and polymorphonuclear cells in the observation group from the 5th day and the 3rd day were significantly lower than those in the control group, the difference was statistically significant (P <0.05). The infection rate in the observation group was 66.67% (30/45) and the control rate was 86.67% (26/30), which was significantly different from the control group (P <0.05). After 30 days of tracheotomy, the removal rates of tracheal tube in the observation group and the control group were 60.0% and 26.7%, respectively, with significant differences (P <0.05). Conclusions Mucosolvan combined with pulmonary lavage can effectively prevent pulmonary infection after tracheotomy in patients with severe craniocerebral injury and can better control lung infection and promote tracheal repair with good clinical efficacy, which is worth in practice Promote use.