支气管肺泡灌洗术联合局部应用敏感抗生素对慢性阻塞性肺疾病合并支气管扩张患者的疗效

doi:10.3760/cma.j.issn.1007-1245.2023.01.011

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (1): 53-.DOI: 10.3760/cma.j.issn.1007-1245.2023.01.011

支气管肺泡灌洗术联合局部应用敏感抗生素对慢性阻塞性肺疾病合并支气管扩张患者的疗效

李书阅¹ 董亮亮¹ 张洪月¹ 宁康²

¹聊城市第二人民医院呼吸科，聊城　252600；²山东第一医科大学第一附属医院呼吸与危重症医学科，济南　250013

出版日期:2023-01-01 发布日期:2023-01-27
通讯作者: 宁康，Email：lishuyue_2013@163.com
基金资助:
山东省自然科学基金（ZR2021MH200）

Effect of bronchoalveolar lavage combined with local application of sensitive antibiotics on patients with chronic obstructive pulmonary disease complicated with bronchiectasis

Li Shuyue¹, Dong Liangliang¹, Zhang Hongyue¹, Ning Kang²

¹Department of Respiratory Medicine, The Second People's Hospital of Liaocheng, Liaocheng 252600, China; ²Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan 250013, China

Online:2023-01-01 Published:2023-01-27
Contact: Ning Kang, Email: lishuyue_2013@163.com
Supported by:
Natural Science Foundation of Shandong Province (ZR2021MH200)

摘要/Abstract

摘要：

目的　分析支气管肺泡灌洗术（BAL）联合局部应用敏感抗生素对慢性阻塞性肺疾病（慢阻肺）合并支气管扩张患者的肺功能、血气分析、炎症因子和气道阻力的影响。方法　回顾性分析2018年1月至2021年1月在聊城市第二人民医院接受治疗的慢阻肺合并支气管扩张患者154例，根据患者是否接受BAL将其分为对照组（63例）和观察组（91例）。对照组男35例、女28例，年龄（58.3±8.3）岁，采用常规治疗；观察组男56例、女35例，年龄（57.8±7.1）岁，在对照组基础上结合BAL治疗。比较两组治疗前和治疗10 d后肺功能指标［肺活量（VC）、第1秒用力呼气量（FEV1）、FEV1占用力肺活量比值（FEV1/FVC）、FEV1占预计值比值（FEV1/pre）、最大呼气流速峰值（PEF）］、血气分析指标［动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）］、炎症因子水平［超敏-C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）、白细胞介素-6（IL-6）］、气道阻力指标［响应频率（Fres）、呼吸总阻抗（Zrs）、5 Hz时总气道阻力/预计值（R5/pre）、中心气道阻力/预计值（R20/pre）、外周弹力阻力（X5）］变化情况和总有效率。采用t检验、χ²检验。结果　治疗后，观察组VC［（2.8±0.4）L］、FEV1［（1.9±0.4）L］、FEV1/FVC［（74.5±11.6）%］、FEV1/pre［（83.2±10.2）%］、PEF［（6.3±1.2）L/s］均高于对照组［（2.3±0.3）L、（1.5±0.3）L、（68.2±12.9）%、（76.8±9.2）%、（5.9±1.1）L/s］，差异均有统计学意义（均P<0.05）。治疗后，观察组PaO₂［（84.9±6.3）%］、SaO₂［（89.4±10.2）%］均高于对照组［（78.9±7.1）%、（84.3±7.5）%］，PaCO₂［（36.9±5.1）mmHg（1 mmHg=0.133 kPa）］低于对照组［（42.8±5.3）mmHg］，差异均有统计学意义（均P<0.05）。治疗后，观察组hs-CRP［（4.3±0.9）mg/L］、TNF-α［（6.3±1.2）ng/L］、PCT［（1.5±0.3）μg/L］、IL-6［（8.4±2.1）ng/L］水平均低于对照组［（8.6±2.1）mg/L、（12.3±3.1）ng/L、（3.2±0.7）μg/L、（20.3±3.5）ng/L］，差异均有统计学意义（均P<0.05）。治疗后，观察组Fres［（18.7±4.6）Hz］、Zrs［（0.4±0.1）kPa/（L·s）］、R5/pre［（184.3±20.5）%］、R20/pre［（186.9±13.8）%］指标均低于对照组［（20.6±4.3）Hz、（0.7±0.1）kPa/（L·s）、（203.1±25.8）%、（215.3±15.0）%］，差异均有统计学意义（均P<0.05）。观察组总有效率为85.7%（78/91），高于对照组65.1%（41/63），差异有统计学意义（χ²=9.026，P=0.003）。结论　BAL联合局部应用敏感抗生素可有效改善慢阻肺合并支气管扩张患者血气值，降低炎性反应和气道阻力，从而有效改善肺功能，提高临床治疗效果。

关键词:

支气管肺泡灌洗, 慢性阻塞性肺疾病, 支气管扩张, 肺功能, 炎症因子, 气道阻力

Abstract:

Objective　To analyze the effects of bronchoalveolar lavage (BAL) combined with local application of sensitive antibiotics on pulmonary function, blood gas analysis, inflammatory factors, and airway resistance in patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. Methods　A retrospective analysis was made on 154 patients with COPD and bronchiectasis who were treated in The Second People's Hospital of Liaocheng from January 2018 to January 2021. They were divided into a control group (63 cases) and an observation group (91 cases) according to whether they received BAL or not. In the control group, 35 males and 28 females, aged (58.3±8.3) years, received routine treatment; in the observation group, 56 males and 35 females, aged (57.8±7.1) years, were treated with BAL on the basis of the control group. The changes of pulmonary function indexes [vital capacity (VC), forced expiratory volume in the first second (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC), ratio of FEV1 to predicted value (FEV1/pre), and peak expiratory flow rate (PEF)], blood gas analysis indexes [arterial partial pressure of oxygen (PaO₂), arterial oxygen saturation (SaO₂), and arterial partial pressure of carbon dioxide (PaCO₂)], levels of inflammatory factors [high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and interleukin-6 (IL-6)], and airway resistance indexes [response frequency (Fres), total respiratory resistance (Zrs), total airway resistance/predicted value at 5 Hz (R5/pre), central airway resistance/predicted value (R20/pre), and peripheral elastic resistance (X5)] before and after 10 d of treatment and the total effective rates of the two groups were compared. t test and χ² test were used. Results　After treatment, the levels of VC [(2.8±0.4) L], FEV1 [(1.9±0.4) L], FEV1/FVC [(74.5±11.6) %], FEV1/pre [(83.2±10.2) %], and PEF [(6.3±1.2) L/s] in the observation group were higher than those in the control group [(2.3±0.3) L,(1.5±0.3) L, (68.2±12.9) %, (76.8±9.2) %, and (5.9±1.1) L/s], with statistically significant differences (all P<0.05). After treatment, the PaO₂ [(84.9±6.3) %] and SaO₂[(89.4±10.2) %] in the observation group were higher than those in the control group [(78.9±7.1) % and (84.3±7.5) %], but the PaCO₂[(36.9±5.1) mmHg (1 mmHg=0.133 kPa)] was lower than that in the control group [(42.8±5.3) mmHg], with statistically significant differences (all P<0.05). After treatment, the levels of hs-CRP [(4.3±0.9) mg/L], TNF-α [(6.3±1.2) ng/L], PCT [(1.5±0.3) μg/L], and IL-6 [(8.4±2.1) ng/L] in the observation group were lower than those in the control group [(8.6±2.1) mg/L, (12.3±3.1) ng/L, (3.2±0.7) μg/L, and (20.3±3.5) ng/L], with statistically significant differences (all P<0.05). After treatment, the Fres [(18.7±4.6) Hz], Zrs [(0.4±0.1) kPa/(L·s)], R5/pre [(184.3±20.5) %], and R20/pre [(186.9±13.8) %] in the observation group were all lower than those in the control group [(20.6±4.3) Hz, (0.7±0.1) kPa/(L·s), (203.1±25.8) %, and (215.3±15.0) %], with statistically significant differences (all P<0.05). The total effective rate of the observation group was 85.7% (78/91), which was higher than that of the control group [65.1% (41/63)], with a statistically significant difference (χ²=9.026, P=0.003). Conclusion　BAL combined with local application of sensitive antibiotics can effectively improve the blood gas value in COPD patients with bronchiectasis, and reduce the inflammatory reaction and airway resistance, thus effectively improving the lung function and clinical treatment effect.

Key words:

Bronchoalveolar lavage, Chronic obstructive pulmonary disease, Bronchiectasis, Lung function, Inflammatory factors, Airway resistance

李书阅董亮亮张洪月宁康.

支气管肺泡灌洗术联合局部应用敏感抗生素对慢性阻塞性肺疾病合并支气管扩张患者的疗效 [J]. 国际医药卫生导报, 2023, 29(1): 53-.

Li Shuyue, Dong Liangliang, Zhang Hongyue, Ning Kang.

Effect of bronchoalveolar lavage combined with local application of sensitive antibiotics on patients with chronic obstructive pulmonary disease complicated with bronchiectasis [J]. International Medicine and Health Guidance News, 2023, 29(1): 53-.

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支气管肺泡灌洗术联合局部应用敏感抗生素对慢性阻塞性肺疾病合并支气管扩张患者的疗效

Effect of bronchoalveolar lavage combined with local application of sensitive antibiotics on patients with chronic obstructive pulmonary disease complicated with bronchiectasis

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