Effect of Early Interventional Therapy with Bronchoscopic Alveolar Lavage on AIDS Patients Complicated with Severe Pneumonia
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摘要:
目的 探讨支气管镜肺泡灌洗术的早期介入治疗对艾滋病并发重症肺炎患者的作用。 方法 选取2018年1月至2021年6月在昆明市第三人民医院重症医学科住院且需有创机械通气支持的成人艾滋病并发重症肺炎患者（44例），分为观察组和对照组，每组分别为22例。观察组除采取常规治疗外早期进行支气管镜肺泡灌洗术，对照组采取常规治疗。对比分析2组患者治疗前后的感染指标、动脉血氧饱和度（SaO2）、动脉氧分压（PaO2）和氧结合指数（PaO2/FiO2）、急性生理和慢性健康评分II（APACHEII）、ICU住院天数、28 d的病死率、机械通气时间和体温恢复正常时间。 结果 （1）观察组在治疗1周后的降钙素原和C反应蛋白指标明显低于对照组（P < 0.05）；（2）观察组在治疗1周后的SaO2、PaO2、PaO2/FiO2比对照组高，差异有统计学意义（P < 0.05）；（3）观察组在治疗1周后，APACHEII评分明显低于对照组，差异有统计学意义（P < 0.05）；观察组机械通气时间、体温恢复时间均短于对照组，差异有统计学意义（P < 0.05）；观察组28 d病死率明显低于对照组，但差异无统计学意义（P > 0.05）；2组患者ICU的住院时间比较差异无统计学意义（P > 0.05）。 结论 早期介入支气管镜肺泡灌洗术治疗艾滋病并发重症肺炎患者，可有效地降低感染指标，减轻机体的炎症性反应，改善氧合，减少有创机械通气时间，对改善预后、提升临床救治效能有重要的意义，值得在临床上应用和普及。 Abstract:Objective To explore the effect of early interventional therapy with bronchoscopic alveolar lavage on AIDS patients complicated with severe pneumonia. Methods Adult AIDS patients complicated with severe pneumonia （44 cases） who were hospitalized in the Department of Intensive Care Unit of the Third People’s Hospital of Kunming from January 2018 to June 2021 and needed invasive mechanical ventilation support were selected. They were divided into observation group and control group , with 22 cases in each group. The observation group was treated with bronchoscopic alveolar lavage on the basis of conventional treatment, the control group received conventional treatment. We compared the efficacy of the two groups before and after treatment such as infectivity index, arterial oxygen saturation, arterial oxygen partial pressure and oxygenation index, APACHE II, hospitalization days in the intensive care unit, 28-day mortality, mechanical ventilation time and the time of body temperature returns to normal. Results （1）After one-week treatment, the procalcitonin and c-reactive protein levels in the observation group were significantly lower than those in the control group （P < 0.05）. （2）The levels of SaO2, PaO2, PaO2/FiO2 in the observation group were higher than those in the control group after one-week treatment, the difference was statistically significant （P < 0.05）. （3）After one-week treatment, the score of APACHE II in the observation group is decrease than the control group, the difference was statistically significant （P < 0.05）. In the observation group, the data about mechanical ventilation time and the time of body temperature returns to normal all lower than those in the control group, the difference was statistically significant （P < 0.05）. The 28-day mortality of the observation group was significantly lower than that of the control group, but the difference was not statistically significant （P > 0.05）. There was no statistically significant difference in Hospitalization days between the two groups （P > 0.05）. Conclusions Early interventional therapy with bronchoscopic alveolar lavage can effectively reduce the infection index, reduce the inflammatory reaction of the body, improve oxygenation, and reduce the time of invasive mechanical ventilation in the treatment of AIDS patients complicated with severe pneumonia. Bronchofiberscope alveolar lavage is of great significance to reduce mortality and improve clinical rescue efficiency, and is worthy of clinical application and popularization. -
Key words:
- Bronchoscopic alveolar lavage /
- Early intervention /
- AIDS /
- Severe pneumonia
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表 1 2组患者基线资料的比较[（
$ \bar x \pm s $ ）/n（%）]Table 1. Comparison of baseline data between the two groups [（
$ \bar x \pm s $ ）/n（%）]项目 观察组（n = 22） 对照组（n = 22） 性别（男/女） 17（77.3）/5（22.7） 16（72.7）/6（27.3） 年龄（岁） 46.4 ± 14.6 47.9 ± 15.4 病原学分类 耶氏肺孢子菌 18（81.8） 17（77.3） 细菌 20（90.9） 20（90.9） 真菌 13（59.1） 12（54.5） 结核 5（22.7） 6（27.3） APACHE Ⅱ评分（分） 25.6 ± 5.3 25.1 ± 5.1 实验室指标 CRP（mg/L） 93.1 ± 15.8 91.9 ± 16.1 PCT（ng/mL） 7.17 ± 1.92 6.21 ± 1.64 SaO2（%） 64.9 ± 3.8 65.6 ± 4.1 PaO2（mmHg） 47.9 ± 5.7 46.7 ± 5.9 PaO2/FiO2（mmHg） 151.8 ± 42.5 149.9 ± 53.1 
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表 2 2组炎症指标的比较（
$ \bar x \pm s $ ）Table 2. Comparison of inflammatory markers between the two groups （
$ \bar x \pm s $ ）组别 CRP（mg/L） PCT（ng/mL） 观察组 41.2 ± 3.9△ 1.32 ± 0.61△ 对照组 63.1 ± 5.5 3.89 ± 0.92 t 6.821 15.454 P < 0.001* < 0.001* *P < 0.05；与对照组比较，△P < 0.05。
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表 3 2组动脉血气的比较（
$ \bar x \pm s $ ）Table 3. Comparison of arterial blood gas between the two groups （
$ \bar x \pm s $ ）组别 SaO2（%） PaO2（mmHg） PaO2/FiO2（mmHg） 观察组 90.6 ± 5.7△ 75.6 ± 7.7△ 203.6 ± 31.3△ 对照组 83.3 ± 3.6 61.7 ± 5.2 171.3 ± 38.1 t 3.527 4.431 5.572 P 0.001* < 0.001* < 0.001* *P < 0.05；与对照组比较，△P < 0.05。
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表 4 2组预后指标的比较[（
$ \bar x \pm s $ ）/n（%）]Table 4. Comparison of prognostic indicators between the two group [（
$ \bar x \pm s $ ）/n（%）]组别 观察组 对照组 t/χ2 P APACHI II 评分（治疗后1周） 17.3 ± 1.7△ 21.7 ± 2.1 2.952 0.004* 住ICU时间（d） 18.6 ± 3.1 18.9 ± 4.2 0.764 0.595 28 d病死率 12（54.6） 16（72.7） 1.571 0.210 机械通气时间（d） 10.3 ± 3.5△ 15.1 ± 4.2 4.257 < 0.001* 体温恢复正常时间（d） 6.5 ± 2.1△ 9.4 ± 3.7 2.518 0.010* *P < 0.05；与对照组比较，△P < 0.05。
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