目的 观察支气管镜吸痰辅助治疗糖尿病合并卒中相关性肺炎(stroke-associated pneumonia,SAP)的效果。方法 选取2017-07至2018-12首都医科大学附属复兴医院住院治疗的86例糖尿病合并SAP患者,其中常规吸痰管吸痰(常规组)66例,支气管镜吸痰(干预组)20例。比较两组临床疗效,痰培养阳性率,抗菌药物使用时间、强度,住院时间、花费及不良反应发生情况。用于评估支气管镜吸痰辅助治疗在糖尿病合并SAP中的效果。结果 在治疗过程中,干预组在基础治疗上给予患者每周1~2次支气管镜吸痰治疗,每人平均行气管镜(1.6±0.6)次,每次平均间隔(7.8±2.3)d。干预组临床总有效率(100%)高于常规组(74.2%),差异有统计学意义(χ²=4.899,P=0.027);干预组痰培养阳性率(70.0%)高于常规组(27.3%),差异有统计学意义(χ²=11.993,P=0.001);干预组抗菌药物使用时间[(8.3±1.9)d]少于常规组[(11.0±8.0)d],干预组抗菌药物使用强度[(10.2±3.2) DDD]低于常规组[(13.5±8.0)DDD],干预组平均住院时间[(11.7±2.5)d]短于常规组[(14.0±11.0)d],干预组平均住院花费[(15 956.2±4472.6)元]少于常规组[(19 673.5±15 041.5)元],以上差异均有统计学意义(P<0.05)。两组患者治疗过程中均未出现咯血,严重心律失常等不良反应。结论 支气管镜吸痰辅助治疗糖尿病合并SAP临床疗效好,痰培养阳性率高,可以减少抗生素使用时间及强度,无严重不良反应。

Objective To observe the therapeutic effect of bronchoscopic sputum aspiration against diabetes mellitus complicated with stroke-associated pneumonia.Methods Eighty-six patients with diabetes mellitus complicated with stroke-associated pneumonia were selected from Fuxing Hospital between July 2017 and December 2018. Among these patients, 66 were treated with the sputum suction tube (routine group) and the rest with sputum suction aided by a bronchoscope (intervention group). The clinical efficacy, sputum culture positive rate, duration and intensity of antimicrobial use, length of hospital stay, cost and adverse reactions were observed and compared between the two groups in order to evaluate the effect of bronchoscopic sputum suction in diabetes mellitus with SAP.Results In the course of treatment, the intervention group was treated with bronchoscopic sputum suction once or twice a week in addition to basic treatment, and each patient was treated with bronchoscopy (1.6±0.6) times, at an average interval of (7.8±2.3) days. The total effective rate (100%) of the intervention group was higher than that of the conventional group (74.2%) (χ²=4.899, P=0.027). The positive rate of sputum culture (70.0%) of the intervention group was higher than that of the conventional group (27.3%) (χ²=11.993, P=0.001). Antibiotics were used for a shorter period of time in the intervention group (8.3±1.9 days) than in the conventional group (11.0±8.0 days) (Z=-2.715, P=0.007). The intensity of antibacterials was lower in the intervention group (10.2±3.2)ddd than in the control group (13.5±8.0) ddd (t=-3.309, P=0.002). The average length of hospital stay in the intervention group (11.7±2.5 days) was shorter than in the conventional group (14.0±11.0) days (Z=-2.421, P= 0.015). The average cost of hospitalization in the intervention group (15956.2±4472.6)yuan was lower than in the conventional group (19673.5±15041.5) yuan (Z=-2.474, P=0.013). There were no adverse reactions such as hemoptysis or serious arrhythmia in either group.Conclusions Bronchoscopic sputum aspiration for diabetes mellitus complicated with stroke-associated pneumonia has good clinical efficacy and high positive rate of sputum culture. It can reduce the duration and intensity of antibiotic use, shorten the hospital stay of patients, reduce hospitalization costs, and cause no serious adverse reactions.