The Research Progress Focus On The Treatment Effect For The Technology Of The Fiberobronchoscopy In ICU Patient With Mechanical Ventilation Associated With Pulmonary Infection

Objective: In recent years,with the improvement of people’s living standard and the change of diet structure,the incidence of stroke increases year by year.Pneumonia is one of the most common medical complications after stroke.Some studies have shown that the occurrence of pneumonia directly affects the recovery of neurological function after stroke,and even has a certain correlation with the occurrence of mortality.At present,for the treatment of SAP has no substantial progress,the use of prophylactic antibiotics is considered can aggravate infection,cause worse prognosis.And at this stage only in Oxygen inhalation,sputum drainage,nutritional support and symptomatic treatment methods.The purpose of this study was to compare the bronchoalveolar lavage and sputum drainage with sputum aspirating tube on the control and treatment of pulmonary infection in patients with SAP,to determine the most effective treatment for this kind of patients to provide new ideas,so as to control infection,improve the prognosis of patients and avoid adverse outcomes.Method: This study is a retrospective study.Select 80 critically ill patients in ICU at Dongguan branch of Affiliated Hospital of Yan’an University diagnosed as parallel mechanical ventilation in the treatment of stroke associated pneumonia（including tracheal intubation and tracheostomy）from December 2014 to December 2016 as the main object of study.They were randomly divided into the following groups: A group（sputum suction group）and B group（lavage group）.All of patients were given the Basic treatments such as:analgesia,sedation,anti infection,Oxygen inhalation,bronchodilators and Symptomatic treatment,often Turn over and backslapping,and encourage the consciousness patient independent expectoration.On the basis of the treatment,the A group was treated with open modified sputum aspiration and sputum culture.The B group based on the A group,ss method,was given the following methods:bronchoalveolar lavage,sputum aspiration,lavage and sputum culture.Records the following indexes before and after treatment of two groups such as:inflammation control,including blood gas indexes after three days: p H（PH）,arterial Partial oxygen pressure（Pa O₂）,arterial Partial carbon dioxide pressure（Pa CO₂）,arterial oxygen saturation（Sa O₂）,inflammatory markers after seven days: white blood cell count（WBC）and procalcitonin（PCT）,C-reactive protein（CRP）and the change of simplified CPIS score（Clinical Pulmonary Infection Score）;Treatment condition（Hospitalization time,mechanical ventilation time,antibiotic use time）and treatment effect（pathogen detection rate,mortality rate,and Modification rate of Intubation to incision）and mortality related factors,to comparative analysis the improvement of pulmonary inflammation and treatment effect for the two groups patients.Result: This study included 80 patients with severe pneumonia after stroke,including A group and B group,each with 40 cases.There was no significant difference in gender,age,basic disease and simplified CPIS score between the two groups（P>0.05）.Comparison of inflammation control: Artetial Blood gas index PH,Pa O₂,Pa CO₂,Sa O₂,inflammatory index WBC,PCT,CRP,CPIS score were compared between two groups before treatment,the difference was not statistically significant（P > 0.05）.After 3 days treatment,the blood gas indexes（PH,Pa O₂,Pa CO₂,Sa O₂）of B group improved significantly compared with before,with statistical significance（P < 0.05）,the degree of improvement in A group was not significant,the treatment effect of B group was significantly better than A group（P < 0.05）.Comparison of the change of the inflammatory index（WBC,PCT,CRP,CPIS score）after treatment for 7 days,CRP and WBC level of two groups patients were improved,and statistically significant（P < 0.05）,B group decreased more obvious than that in A group（P < 0.05）;The change of CPIS score,and PCT index for A group before and after treatment is not obvious,after treatment,B group significantly decreased than before（P < 0.05）,and B group improved more obvious than A group with statistical significance（P < 0.05）,also the clinical manifestations,imaging results have the corresponding changes in the before or after treatment of two groups.Treatment condition:In this study,the hospitalization time of group B（14.18 + 3.18d）,duration of mechanical ventilation（25.59h）time and use time of antibiotics（7.05 + 1.20d）are shorter than group A（55.42 h,20.30 + 4.59 d,12.83 + 2.72d）,and with statistically significant（P < 0.05）.Comparison of therapeutic effect: after treatment,the pathogen detection rate of B group was 56.9%,which was higher than that of A group（43.1%）,and the difference was significant between the two groups（P < 0.05）.The Modification rate（37.1%）and mortality rate（40.0%）in the B group were lower than those in the corresponding A group（62.9%,62.5%）,and the difference was statistically significant（P < 0.05）.Analysis of the influencing factors of mortality: through the analysis of all the factors in this study,found that the main factors affecting the mortality of A,B group is the basic disease,blood gas indicators and inflammatory indicators before and after treatment.Such as: PH,Pa O₂,Pa CO₂,PCT,CPIS score before and after treatment and the significance of the Sa O₂,WBC,CRP and other indicators（P < 0.05）,each index has real meaning.Conclusion: 1.Fiberoptic bronchoscopy lavage clearly improve the blood gas index and inflammatory index,effectively alleviate the symptoms of patients with pulmonary infection.It can indirectly reduce the mortality and modification rate of patient,and improve the detection rate of pathogen.It is good for the long-term neurological recovery in patients with stroke and the quality of life and shorten the time of hospitalization time,mechanical ventilation time and antibiotic use time,reduce the economic burden of patients and saving the medical resources.2 the main factors affecting the mortality were the blood gas indexes and inflammatory indexes before and after treatment.After treatment,PH,Pa O₂,Pa CO₂,PCT,CPIS score determine the effect of treatment of pneumonia has a positive significance.For the treatment of Sa O₂,WBC,CRP can be considered not only reflect the effect of the treatment of the pneumoria,but also evaluate the severity of the patient’s admission and predict the outcome and prognosis of patients.3 simplified CPIS scoring system can play an important role in evaluating the therapeutic effect and prognosis of patients with SAP,and it can provide new ideas for future evaluation criteria for SAP patients.