支气管肺泡灌洗在老年慢性阻塞性肺疾病合并重症肺炎患者中的价值研究

The value of bronchoalveolar lavage in elderly patients with COPD and severe pneumonia

摘要:

目的 探讨肺泡灌洗术在老年慢性阻塞性肺疾病（COPD）合并重症肺炎患者治疗中的临床价值及预后。方法 选取2017年1月—2020年1月永康市第一人民医院重症医学科收治的老年COPD合并重症肺炎患者118例，根据随机数字表法分为对照组和观察组，每组59例。对照组患者给予常规治疗，观察组患者在对照组基础上给予支气管肺泡灌洗（BAL）治疗。比较两组患者临床症状消失时间、抗菌药物使用时间、住院时间、血氧指标、临床疗效及病死率。结果 观察组患者临床症状消失时间、抗菌药物使用时间及住院时间均短于对照组（P <0.05）。两组患者治疗前后pH值的差值比较，差异无统计学意义（P >0.05）；观察组治疗前后PaO₂、SpO₂、PaCO₂的差值大于对照组（P <0.05）。观察组临床疗效好转率高于对照组（P <0.05），病死率低于对照组（P <0.05）。结论 老年COPD合并重症肺炎患者应用BAL治疗，能够有效缩短临床症状消失时间，缩短抗菌药物使用时间及住院时间，改善肺部血液循环，提高患者预后和生存率。

Abstract:

Objective To investigate the clinical value of bronchoalveolar lavage (BAL) in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) complicated by severe pneumonia and its effects on the prognosis.Methods A total of 118 elderly COPD patients with severe pneumonia admitted to the Department of Critical Care Medicine of Yongkang First People's Hospital from January 2017 to January 2020 were selected and divided into control group and observation group according to random number table method, with 59 cases in each group. Patients in the control group were given conventional treatment, and patients in the observation group were treated with bronchoalveolar lavage (BAL) on the basis of the control group. The time to symptom disappearance, duration of antibiotic use, length of hospital stay, blood oxygen parameters, clinical efficacy and mortality were compared between the two groups.Results The time to symptom disappearance, duration of antibiotic use and length of hospital stay of the observation group were shorter than those of the control group (P < 0.05). The difference of pH value before and after treatment in the observation group did not differ from that in the control group (P > 0.05). The differences of partial pressure of oxygen (PaO₂), oxygen saturation (SpO₂), and partial pressure of carbon dioxide (PaCO₂) before and after treatment were higher in the observation group than in the control group (P < 0.05). The clinical efficacy of the observation group was higher than that of the control group (P < 0.05), while the mortality of the observation group was lower than that of the control group (P < 0.05).Conclusions The application of BAL in elderly patients with COPD and severe pneumonia can effectively shorten the time to symptom disappearance, duration of antibiotic use, and length of hospital stay. Besides, it enhances blood circulation in the lungs, and improves the prognosis and survival rate of patients.