Effect of high-frequency chest wall oscillation combined with bronchoscope lavage in treatment of ischemic stroke associated pneumonia
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摘要:目的 探讨高频胸壁震荡（HFCWO）联合支气管镜灌洗治疗缺血性脑卒中相关性肺炎的临床效果。方法 选择60例缺血性脑卒中相关性肺炎患者，随机分为观察组和对照组，每组30例。在常规治疗的基础上，对照组采用支气管镜灌洗治疗，观察组采用支气管镜灌洗联合HFCWO治疗。比较2组疗效、血气指标、炎性因子、痰液量、肺部感染评分（CPIS）和Barthel指数（BI）变化情况。结果 观察组治疗总有效率高于对照组，差异有统计学意义（P < 0.05）。治疗第7、14、21天时，观察组动脉血氧分压[pa（O2）]、氧合指数[pa（O2）/FiO2]、BI评分高于对照组，动脉血二氧化碳分压[pa（CO2）]、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）、C反应蛋白（CRP）和CPIS评分低于对照组，差异有统计学意义（P < 0.001）。结论 HFCWO联合支气管镜灌洗治疗缺血性脑卒中相关性肺炎，可优化呼吸道管理，有效控制肺部感染和炎症反应，改善氧合指数，提高患者临床疗效和生活能力。Abstract:Objective To investigate the clinical effect of high-frequency chest wall oscillation (HFCWO) combined with bronchoscopy lavage in treatment of ischemic stroke associated pneumonia.Methods Sixty patients with ischemic stroke associated pneumonia were randomly divided into observation group and control group, with 30 cases in each group. On basics of the usual treatment, the control group was treated with bronchoscopy lavage, while the observation group was treated with bronchoscopy lavage combined with HFCWO. The curative effect, blood gas index, inflammatory factors, sputum volume, pulmonary infection score (CPIS) and Barthel index (BI) were compared between the two groups.Results The total effective rate of the observation group was significantly higher than that of the control group (P < 0.05). On the 7th, 14th and 21st day of treatment, arterial partial pressure of oxygen[pa(O2)], oxygenation index[pa(O2)/FiO2] and BI scores in observation group were significantly higher than those in the control group, arterial partial pressure of carbon dioxide[pa(CO2)], tumor necrosis factor-α (TNF-α), procalcitonin (PCT), C-reactive protein (CRP) and CPIS scores were significantly lower than those in the control group.Conclusion HFCWO combined with bronchoscopy lavage in the treatment of ischemic stroke associated pneumonia can optimize respiratory tract management, effectively control pulmonary infection and inflammatory response, improve oxygenation index, and enhance clinical efficacy and living ability of patients.
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Keywords:
- bronchoscopy lavage /
- chest wall concussion /
- ischemic stroke /
- pneumonia
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表 1 2组基线资料(x±s)[M(Q1, Q3)][n(%)]
一般资料 观察组(n=30) 对照组(n=30) 年龄/岁 68.25±8.46 69.94±7.08 性别 男 19(63.33) 16(53.33) 女 11(36.67) 14(46.67) 脑卒中病程/d 13.26(9.00, 16.00) 12.91(8.00, 16.00) 治疗前肺炎病程/d 3.26(1.00, 6.00) 3.16(1.00, 5.00) 治疗前CPIS/分 7.91±3.65 7.95±3.93 肺炎治疗疗程/d 15.01±3.34 15.13±3.26 NHISS评分/分 12.32±3.42 12.09±3.27 感染病原菌种类 肺炎链球菌 23(76.77) 20(66.67) 肺炎克雷伯杆菌 15(50.00) 13(43.33) 大肠埃希菌 17(56.67) 14(46.67) 其它 2(6.67) 5(16.67) 抗生素 β-内酰胺类 26(86.67) 23(76.67) 头霉素类 10(33.33) 8(26.67) 氧头孢烯类 15(50.00) 17(56.67) 其它 6(20.00) 3(10.00) 合并症 糖尿病 19(63.33) 17(56.67) 高血压 20(66.67) 17(56.67) 高脂血症 16(53.33) 14(46.67) CPIS: 肺部感染评分; NIHSS: 美国国立卫生院神经功能缺损。 
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表 2 2组治疗期间痰液量变化和差异(x±s)
mL 组别 n 治疗前 治疗第7天 治疗第14天 治疗第21天 观察组 30 32.15±6.29 24.12±5.11**▲▲ 15.32±3.56**##▲▲ 6.35±2.02**##△△▲▲ 对照组 30 32.51±6.95 28.15±6.59** 20.35±5.49**## 12.35±3.11**##△△ 与治疗前比较, **P < 0.01; 与治疗第7天比较, ##P < 0.01; 与治疗第14天比较, △△P < 0.01; 与对照组比较, ▲▲P < 0.01。
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表 3-1 2组血气指标变化(x±s)
mmHg 组别 时点 pa(CO2) pa(O2) pa(O2)/FiO2 观察组(n=30) 治疗前 58.41±6.98 63.35±6.15 151.65±36.73 治疗第7天 48.26±4.16***▲▲▲ 73.26±7.19***▲▲▲ 189.35±45.02***▲▲▲ 治疗第14天 42.24±3.59***###▲▲▲ 82.35±8.46***###▲▲▲ 223.52±58.07***###▲▲▲ 治疗第21天 36.24±3.03***###△△△▲▲▲ 92.42±9.57***###△△△▲▲▲ 243.15±63.84***###△△△▲▲▲ 对照组(n=30) 治疗前 58.63±6.72 63.91±6.08 152.44±37.92 治疗第7天 52.31±5.07*** 67.02±7.52*** 165.02±42.73*** 治疗第4天 47.26±4.76***### 75.32±7.95***### 185.02±49.24***### 治疗第21天 43.25±3.59***###△△△ 80.24±8.32***###△△△ 211.35±53.47***###△△△ pa(CO2): 动脉血二氧化碳分压; pa(O2): 动脉血氧分压; pa(O2)/FiO2: 氧合指数。
与治疗前比较, ***P < 0.001; 与治疗第7天比较, ###P < 0.001; 与治疗第14天比较, △△△P < 0.001; 与对照组比较, ▲▲▲P < 0.001。
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表 3-2 2组炎性因子变化(x±s)
组别 时点 TNF-α/(ng/mL) PCT/(μg/L) CRP/(mg/L) 观察组(n=30) 治疗前 9.35±2.96 4.21±0.68 73.26±6.25 治疗第7天 7.26±2.32***▲▲▲ 2.11±0.54***▲▲▲ 50.12±3.01***▲▲▲ 治疗第14天 5.74±2.23***###▲▲▲ 1.03±0.41***###▲▲▲ 30.86±2.64***###▲▲▲ 治疗第21天 4.92±2.15***###△△△▲▲▲ 0.76±0.22***###△△△▲▲▲ 6.42±2.13***###△△△▲▲▲ 对照组(n=30) 治疗前 9.42±2.87 4.25±0.81 73.35±6.46 治疗第7天 8.52±2.05*** 2.82±0.62*** 52.85±3.05*** 治疗第4天 7.82±1.96***### 1.11±0.47***### 30.94±2.93***### 治疗第21天 6.83±1.63***###△△△ 0.90±0.31***###△△△ 8.02±2.17***###△△△ TNF-α: 肿瘤坏死因子-α; PCT: 降钙素原; CRP: C反应蛋白。
与治疗前比较, ***P < 0.001; 与治疗第7天比较, ###P < 0.001; 与治疗第14天比较, △△△P < 0.001; 与对照组比较, ▲▲▲P < 0.001。
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表 4 2组治疗期间CPIS、BI评分变化和差异(x±s)
分 组别 时点 肺部感染评分 Barthel指数 观察组(n=30) 治疗前 7.91±3.65 51.42±7.19 治疗第7天 5.24±1.97***▲▲▲ 62.35±8.46***▲▲▲ 治疗第14天 4.91±1.80***###▲▲▲ 73.42±9.22***###▲▲▲ 治疗第21天 4.68±1.72***###△△△▲▲▲ 76.05±9.42***###△△△▲▲▲ 对照组(n=30) 治疗前 7.95±3.93 52.42±7.91 治疗第7天 6.75±2.42*** 56.02±8.19*** 治疗第14天 6.31±2.39***### 61.24±8.33***### 治疗第21天 6.06±2.06***###△△△ 65.81±8.45***###△△△ 与治疗前比较, ***P < 0.001; 与治疗第7天比较, ### P < 0.001; 与治疗第14天比较，△△△P < 0.001;
与对照组比较, ▲▲▲P < 0.001。
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