支气管肺泡灌洗术对成人重症肺炎疗效及sICAM-1、IL-6水平的影响

doi:10.3760/cma.j.cn441417-20240722-15020

摘要/Abstract

摘要：

目的　评估支气管肺泡灌洗术对成人重症肺炎疗效以及对血清可溶性细胞间黏附分子-1（sICAM-1）和白细胞介素-6（IL-6）水平的影响。方法　共纳入安康市中医医院2020年1月至2023年12月收治的102例成人重症肺炎患者，采用随机分层抽样法将患者分为对照组和研究组。对照组男28例，女23例；年龄45～70（58.24±6.53）岁；体重指数（24.56±3.21）kg/m²；病程7～20（12.48±3.67）d。研究组男27例，女24例；年龄46～69（57.92±6.28）岁；体重指数（24.78±3.15）kg/m²；病程8～19（12.35±3.54）d。对照组接受盐酸氨溴索注射液治疗，15 mg盐酸氨溴索与50 ml 5%葡萄糖注射液混合后静脉滴注，滴注时间约30 min，每日两次；研究组在此基础上联合电子支气管镜支气管肺泡灌洗术治疗，每周1～2次，两组均治疗14 d。比较两组患者临床症状（咳嗽、咳痰、发热）消失时间，血清指标（sICAM-1、IL-6）、呼吸力学指标［气道阻力（RAW）、肺动态顺应性（Cdyn）、呼吸做功量（WOB）］、临床肺部感染评分（CPIS）、急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和不良反应（恶心、皮肤瘙痒、气道出血、气道痉挛、腹泻）发生情况。统计学方法采用t检验、χ²检验。结果　研究组咳嗽、发热、咳痰消失时间为（2.22±1.11）d、（1.46±0.38）d、（2.41±0.34）d，短于对照组（6.45±1.06）d、（2.51±0.57）d、（5.77±0.82）d，差异均有统计学意义（t=19.682、10.946、27.031，均P<0.05）。治疗14 d后，研究组的sICAM-1和IL-6水平为（134.51±28.17）μg/L、（17.41±1.53）μg/L，低于对照组（168.25±35.44）μg/L、（23.20±1.86）μg/L，差异均有统计学意义（t=5.322、17.168，均P<0.05）；研究组的RAW和WOB为（9.71±2.15）cmH₂O/（L·s）（1 cmH₂O=0.098 kPa）、（0.53±0.09）J/L，低于对照组（11.87±2.68）cmH₂O/（L·s）、（0.65±0.14）J/L，Cdyn为（36.84±4.99）ml/cmH₂O，高于对照组（32.63±4.85）ml/cmH₂O，差异均有统计学意义（t=4.490、5.149、4.321，均P<0.05）；研究组的CPIS和APACHEⅡ评分为（3.41±0.83）分、（11.65±2.74）分，低于对照组（4.76±1.21）分、（14.55±3.19）分，差异均有统计学意义（t=6.570、4.925，均P<0.05）。研究组的不良反应发生率为3.92%（2/51），低于对照组的13.73%（7/51），但差异无统计学意义（χ²=3.047，P=0.081）。结论　支气管肺泡灌洗术能有效改善成人重症肺炎患者的临床症状，降低sICAM-1和IL-6水平，改善呼吸力学指标，并降低CPIS和APACHEⅡ评分，显示出较高的安全性和耐受性。

关键词:

重症肺炎, 成人, 支气管肺泡灌洗术, 临床症状, 血清指标

Abstract:

Objective　To evaluate the efficacy of bronchoalveolar lavage for adult severe pneumonia and its effects on serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-6 (IL-6). Methods　A total of 102 adult patients with severe pneumonia who were admitted to Ankang Hospital of Traditional Chinese Medicine from January 2020 to December 2023 were included. The patients were divided into a control group and a study group using the stratified random sampling method. In the control group, there were 28 males and 23 females; the age ranged from 45 to 70 (58.24±6.53) years old; the body mass index was (24.56±3.21) kg/m²; the disease duration was 7 to 20 (12.48 ± 3.67) days. In the study group, there were 27 males and 24 females; the age ranged from 46 to 69 (57.92±6.28) years old; the body mass index was (24.78±3.15) kg/m²; the disease duration was 8 to 19 (12.35±3.54) days. The control group received treatment with ambroxol hydrochloride injection: 15 mg of ambroxol hydrochloride was mixed with 50 ml of 5% glucose injection and then administered intravenously, lasting for about 30 minutes, twice a day. The study group received additional electronic bronchoalveolar lavage, 1 to 2 times per week. Both groups received treatment for 14 days. The resolution time of clinical symptoms (cough, expectoration, and fever) were compared between the two groups, as well as the serum markers (sICAM-1 and IL-6), respiratory mechanics parameters [airway resistance (RAW), dynamic lung compliance (Cdyn), and work of breathing (WOB)], Clinical Pulmonary Infection Score (CPIS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the occurrence of adverse reactions (nausea, skin itching, airway bleeding, airway spasm, and diarrhea). Statistical methods used were t test and χ² test. Results　The resolution time for cough, fever, and expectoration in the study group were (2.22±1.11) days, (1.46±0.38) days, and (2.41±0.34) days, which were shorter than those in the control group [(6.45±1.06) days, (2.51±0.57) days, and (5.77±0.82) days], with statistically significant differences (t = 19.682, 10.946, and 27.031; all P<0.05). After 14 days of treatment, the levels of sICAM-1 and IL-6 in the study group were (134.51±28.17) μg/L and (17.41±1.53) μg/L, which were lower than those in the control group [(168.25±35.44) μg/L and (23.20±1.86) μg/L], with statistically significant differences (t = 5.322 and 17.168; both P<0.05). The RAW and WOB values of the study group were (9.71±2.15) cmH₂O/(L·s) (1 cmH₂O = 0.098 kPa) and (0.53±0.09) J/L, which were lower than those of the control group [(11.87±2.68) cmH₂O/(L·s) and (0.65±0.14) J/L]; the Cdyn value was (36.84±4.99) ml/cmH₂O, which was higher than that of the control group [(32.63±4.85) ml/cmH₂O], with statistically significant differences (t = 4.490, 5.149, and 4.321, all P<0.05). The CPIS and APACHE II score of the study group were (3.41±0.83) points and (11.65±2.74) points, which were lower than those of the control group [(4.76±1.21) points and (14.55±3.19) points], with statistically significant differences (t = 6.570 and 4.925; both P<0.05). The incidence of adverse reactions in the study group was 3.92% (2/51), which was lower than that in the control group [13.73% (7/51)], but the difference was not statistically significant (χ²=3.047, P=0.081). Conclusion　Bronchoalveolar lavage can effectively alleviate the clinical symptoms of adult patients with severe pneumonia, reduce the levels of sICAM-1 and IL-6, improve the respiratory mechanics indicators, and lower the CPIS and APACHE II score, demonstrating high safety and tolerance.

Key words:

Severe pneumonia, Adult, Bronchoalveolar lavage, Clinical symptoms, Serum indicators

陈学前雷莲莲周桂智.

支气管肺泡灌洗术对成人重症肺炎疗效及sICAM-1、IL-6水平的影响 [J]. 国际医药卫生导报, 2025, 31(15): 2568-2573.

Chen Xueqian, Lei Lianlian, Zhou Guizhi.

Effectiveness of bronchoalveolar lavage in adult severe pneumonia and its impacts on sICAM-1 and IL-6 levels [J]. International Medicine and Health Guidance News, 2025, 31(15): 2568-2573.

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