摘要
目的 探讨纤维支气管镜肺泡灌洗(FBAL)辅助治疗对重症肺炎呼吸力学指标、炎症因子、微RNA(miR-NA)的影响.方法 前瞻性选取2021年6月至2024年6月于南方医科大学顺德医院(佛山市顺德区第一人民医院)治疗的重症肺炎患者80例作为研究对象,按照随机数字表法将其分为试验组(n=40)、对照组(n=40).对照组行基础治疗+盐酸溴己新治疗,试验组行基础治疗+盐酸溴己新+FBAL治疗.比较两组的临床疗效,比较两组治疗前及治疗后7 d的呼吸力学指标[肺动态顺应性(Cdyn)、呼吸做功(WOB)、气道峰压(PIP)]、血清炎症因子[白细胞介素(IL)-6、肿瘤坏死因子-a(TNF-a)、IL-8]水平、血清miRNA-223、miRNA-127等指标,并观察两组不良反应发生情况.结果 试验组总有效率为92.50％,高于对照组(75.00％),差异有统计学意义(P＜0.05).治疗后7 d,两组Cdyn均较治疗前增大,WOB、PIP均较治疗前减小,且试验组Cdyn为(37.65±3.98)mL/cmH2 0,大于对照组[(32.47±3.55)mL/cmH2O],WOB、PIP 分别为(0.29±0.03)J/L、(16.19±1.84)cmH2O,均小于对照组[(0.36±0.04)J/L、(20.07±2.26)cmH2O],差异均有统计学意义(P＜0.05).治疗后7 d,两组IL-6、TNF-a、IL-8水平均较治疗前降低,且试验组的IL-6、TNF-a、IL-8 水平分别为(33.89±3.54)ng/mL、(71.57±7.32)ng/mL、(34.56±3.63)ng/mL,均低于对照组[(41.65±4.32)ng/mL、(81.54±8.38)ng/mL、(42.62±4.40)ng/mL],差异均有统计学意义(P＜0.05).治疗后 7 d,两组 miRNA-223、miRNA-127 均较治疗前降低,且试验组 miRNA-223、miRNA-127 分别为 1.60±0.17、1.76±0.19,均低于对照组(1.92±0.20、2.11±0.23),差异均有统计学意义(P＜0.05).试验组与对照组不良反应发生率比较(17.50％vs.5.00％),差异无统计学意义(P＞0.05).结论 FBAL辅助治疗重症肺炎可提高疗效,改善患者呼吸力学,抑制炎症反应,改善miRNA水平,安全性高.
Abstract
Objective To study the effect of fiberoptic bronchoscopy alveolar lavage(FBAL)adjuvant therapy on respiratory mechanics indexes,inflammatory factors and microRNA(miRNA)in severe pneumonia.Methods A total of 80 patients with severe pneumonia who were treated in Shunde Hospital of Southern Medical University(First People's Hospital of Shunde District,Foshan City)from June 2021 to June 2024 were prospectively selected as the research objects.They were divided into experimental group(n=40)and control group(n=40)according to the random number table method.The control group received basic treatment+bromhexine hydrochloride treatment,and the experimental group received basic treatment+bromhexine hydrochloride+FBAL treatment.The clinical effect of the two groups was observed.The clinical efficacy of the two groups was compared.The respiratory mechanics indexes[compliance dynamic(Cdyn),work of breathing(WOB),peak airway pressure(PIP)],serum inflammatory factors[interleukin(IL)-6,tumor necrosis factor-α(TNF-α),IL-8]levels,serum miRNA-223,miRNA-127 and other indicators before treatment and 7 days after treatment were compared between the two groups,and the occurrence of adverse reac-tions in the two groups was observed.Results The total effective rate of the experimental group was 92.50％,which was higher than that of the control group(75.00％),and the difference was statistically significant(P＜0.05).At 7 days after treatment,Cdyn in the two groups was in-creased when compared with that before treatment,and WOB and PIP were decreased when compared with those before treatment,and Cdyn in the experimental group was(37.65±3.98)mL/cmH2O,which was larger than that in the control group[(32.47±3.55)mL/cmH2O],and WOB and PIP in the experimental group were(0.29±0.03)J/L and(16.19±1.84)cmH2O respectively,which were smaller than those in the con-trol group[(0.36±0.04)J/L and(20.07±2.26)cmH2O],the differences were statistically significant(P＜0.05).At 7 days after treat-ment,the levels of IL-6,TNF-α and IL-8 in the two groups were lower than those before treatment,and the levels of IL-6,TNF-α and IL-8 in the experimental group were(33.89±3.54)ng/mL,(71.57±7.32)ng/mL and(34.56±3.63)ng/mL,respectively,which were lower than those in the control group[(41.65±4.32)ng/mL,(81.54±8.38)ng/mL and(42.62±4.40)ng/mL],the differences were sta-tistically significant(P＜0.05).At 7 days after treatment,the levels of miRNA-223 and miRNA-127 in the two groups were lower than those before treatment,and the levels of miRNA-223 and miRNA-127 in the experimental group were 1.60±0.17 and 1.76±0.19,respectively,which were lower than those in the control group(1.92±0.20 and 2.11±0.23),the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of adverse reactions between the experimental group and the control group(17.50％vs.5.00％)(P＞0.05).Conclusion FBAL adjuvant therapy on severe pneumonia can improve the efficacy of patients,improve the respiratory mechanics index of patients,inhibit the inflammatory response,improve the level of miRNA,and have high safety.
维普
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