Effect Of Bronchoscopic Sputum Aspiration Combined With Alveolar Lavage On The Clinical Efficacy Of Patients With Ventilator-Associated Pneumonia

Objective:To explore the therapeutic value of sputum aspiration combined with bronchoalveolar lavage in patients with ventilator-associated pneumonia（VAP）.Methods:This study plans to randomly select 70 patients who were admitted to the respiratory intensive care unit（RICU）,intensive care unit（ICU）and emergency intensive care unit（EICU）of Taizhou People’s Hospital from September 2021 to November 2022,according to the diagnostic criteria of ventilator-associated pneumonia（VAP）in the message of Guidelines for the Diagnosis and Treatment of Chinese Adult Hospital-Acquired Pneumonia and Ventilator-associated Pneumonia（2018 Edition）developed by the Infectiology Group of the Respiratory Branch of the Chinese Medical Association,VAP refers to the pneumonia of patients with endotracheal intubation or tracheotomy after 48 hours of mechanical ventilation.Pneumonia occurred within 48 hours after withdrawal and extubation still belongs to VAP.The patients who met the diagnostic criteria of VAP were randomly divided into control group and test group,with 35 patients in each group.The patients in the control group were given routine treatment:raising the head of the bed（30～45°）,physical expectoration（turning over and patting the back every 2 hours,drainage and expectoration in specific positions,sputum aspirator suction,vibration and expectoration）,rational sedation and analgesia,prevention of stress ulcer,elimination of airway spasm,rational use of antibiotics,prevention of deep vein thrombosis,oral care and airway care（conventional sputum aspiration and airway humidification）,appropriate enteral or parenteral nutrition,etc.The test group was treated with bronchofiberscope sputum aspiration combined with alveolar lavage at the same time of routine treatment.The length of stay in ICU,mechanical ventilation time,clinical pulmonary infection score（CPIS）before and after treatment,treatment effect,serum inflammatory factors including C-reactive protein（CRP）,interleukin-6（IL-6）,respiratory function index,peak airway pressure（PIP）,airway resistance（RAW）,procalcitonin（PCT）and interleukin-8（IL-8）,arterial blood gas analysis index,arterial oxygen partial pressure（PaO₂）The arterial oxygen saturation（SaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）,lactic acid（Lac）and oxygenation index（OI）were analyzed and the safety of treatment was evaluated.Result:The CPIS score of the test group after treatment was lower than that of the control group,and the difference was statistically significant（P<0.05）,explain the clinical manifestation,lung imaging,pathogenic microorganism and other aspects of the system,it shows that the system evaluates the development of pulmonary infection from two aspects in clinical manifestations,lung imaging,pathogenic microorganisms and so on,hoping to play a certain guiding role in clinical work.Compared with the control group,the curative effect of patients in the test group was better,and the difference was statistically significant（P<0.05）,it shows that the treatment of sputum aspiration and alveolar lavage with fiberbronchoscope can effectively treat patients with VAP and significantly improve the clinical efficacy.After treatment,the improvement of inflammatory indexes such as IL-6,IL-8,CRP and PCT in the test group was significantly better than that in the control group（P<0.05）,it shows that bronchoscope can not only absorb the secretion of each segment of bronchus,but also promote the absorption of inflammation,which is of great significance for improving the symptoms and prognosis of patients.Compared with the control group,it was found that the PIP and RAW of patients in the test group were significantly decreased after treatment（P<0.05）,it suggests that the patient’s respiratory function has been significantly improved.After treatment,the blood gas analysis indexes such as PaO₂,Pa CO₂,SaO₂,Lac and OI in the test group were significantly improved（P<0.05）,through bronchofibroscope alveolar lavage,not only the lung ventilation and ventilation functions of VAP patients under hypoxia can be significantly improved,but also PaCO₂ and Lac can be significantly reduced,and PaO₂,SaO₂ and OI can be increased.Conclusion:Compared with the routine treatment of ventilator-associated pneumonia,fiberbronchoscopic sputum aspiration and alveolar lavage can improve the treatment efficiency and enhance the treatment effect of patients;It can improve inflammation index and blood gas index,alleviate the condition of lung inflammation,and reduce mortality;it can improve the index of respiratory function and relieve the patient of hypoxia.In addition,as a safe operation,fiberbronchoscopic sputum aspiration combined with alveolar lavage is worthy of clinical application.