摘要
目的:评价在颈髓损伤后肺不张并感染患者中联合应用支气管肺泡灌洗与机械通气的效果。方法:将2005年6月～2008年5月我院42例颈髓损伤气管切开术后发生肺不张合并肺部感染的患者随机分为两组,每组21例,A组接受常规治疗(包括抗生素、化痰、湿化气道、拍背促进排痰、营养及支持治疗)及联合应用支气管肺泡灌洗(BAL)与呼吸机辅助通气治疗,B组仅行常规治疗,比较两组患者的治疗效果。结果:A组患者治愈12例,显效5例,好转2例,无效2例,有效率为90.5%;B组治愈8例,显效4例,好转3例,无效6例,有效率为71.4%,两组比较有显著性差异(P<0.01)。A组患者抗感染时间为8.1±0.5d,B组为12.3±0.7d,两组比较有显著性差异(P<0.01)。A组发生窒息和呼吸衰竭各1例(发生率为9.5%),B组分别为2例和4例(发生率为28.6%),两组发生率比较有显著性差异(P<0.01)。B组1例因呼吸循环衰竭死亡。A组患者在BAL治疗过程中,3例血氧饱和度降至80%以下,经暂停操作、呼吸机辅助呼吸后恢复并完成治疗;5例发生心动过速,3例发生心动过缓,无心跳骤停发生。结论:在颈髓损伤后肺不张并感染患者中联合应用支气管肺泡灌洗与机械通气可提高有效率,缩短治疗时间,减少窒息和呼吸衰竭的发生,改善预后。
Objective：To investigate the clinical outcome of bronvhoalveolar lavage （BAL） and mechanical ventilation for the treatment of pulmonary closure complicated with infection due to cervical cord injury. Method：42 patients with cervical cord injury and complicated with pulmonary infection after tracheotomy due to SCI were included in this study.All patients were randomized into 2 groups with each group of 21.Routine management（including antibiotics,eliminate sputum,humidificate airway,clap back to facilitate to exclude sputum,nutrition and supportive treatment） and BAL with assisted ventilation were administered in group A.Patients in group B underwent routine management alone.The clinic outcome of 2 groups were reviewed comparatively.Result：In group A, 12 patients healed completely,7 patients improved partially,2 patients had poor outcome,with the total improve rate of 90.5%.While in group B,8 patients healed completely,7 patients improved partially,6 patients had poor outcome,with the improverate of 71.4%,the difference was significant between 2 groups （P〈0.01）.The infection duration of group A was 8.1±0.5 days,and group B was 12.3±0.7 days,with significant difference （P〈0.01）.In group A,1 case was complicated with respiratory failure and 1 case with asphyxia （the incidence was 9.5%）,while in group B,the occurrence of respiratory failure and asphyxia was 2 and 4 cases（the incidence was 28.6%） respectively,which have significant difference（P〈0.01）,1 patient in group B died of respiratory and circulatory failure.During the procedure of BAL in group A,the saturation of blood oxygen decreased to no more than 80% in 3 patients,who recovered eventually by suspending the operation and assisted ventilation,5 patients had taehycardia,3 patients had bradycardia,while no cardiac arrest were noted.Conclusion：Use of the BLA and assisted ventilation is effective to deal with pulmonary closure complicated with infection due to SCI,whieh can shorten the time of treatment and decrease the
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2009年第1期15-18,共4页
Chinese Journal of Spine and Spinal Cord
关键词
颈髓损伤
肺不张
肺部感染
机械通气
支气管肺泡灌洗
Cervical cord impairment
Pulmonary closure
Pulmonary infection
Assited ventilation
Bron-vhoalveolar lavage
