摘要目的 探讨高压氧(hyperbaric oxygen,HBO)联合敏感抗生素支气管肺泡灌洗治疗重症颅脑损伤继发肺部感染的临床疗效.方法 选取同济大学蓝十字脑科医院2017年1月至2018年11月收治人院187例重症颅脑损伤患者,所有人选对象的诊断标准参照中国神经外科重症患者感染诊治专家共识.按照数字表随机分成3组,HBO综合稀释抗生素溶液肺泡灌洗治疗组(Ⅰ组)63例、抗生素稀释溶液肺泡灌洗治疗组(Ⅱ组)63例和静脉抗生素治疗组(Ⅲ组)61例.分别采用上述不同治疗方案,治疗30 d后观察3组患者治疗前后动脉血氧分压、GCS评分的变化,并比较机械通气时间、住ICU时间和临床疗效.结果 治疗3个疗程后,3组患者血氧分压和GCS评分与本组治疗前比较均明显提高,差异有统计学意义(P＜0.01),且Ⅰ组患者血氧分压明显高于其他2组,差异均有统计学意义(P＜0.05);Ⅰ组患者机械通气时间和住ICU时间均明显低于Ⅱ组、Ⅲ组,差异有统计学意义(P＜0.05或P＜O.01);而且Ⅰ组总有效率(92.1％)明显高于Ⅱ组(84.1％)和Ⅲ组(77.1％),差异均有统计学意义(P＜0.05).结论 HBO联合敏感抗生素支气管肺泡灌洗治疗重症颅脑损伤继发肺部感染疗效显著,值得临床进一步推广应用.

abstractsObjective To investigate clinical effects of hyperbaric oxygen (HBO) combined with sensitive antibiotic alveolar wash on severe craniocerebral injury complicated with pulmonary infection.Methods One hundred and eighty-seven patients with severe craniocerebral injury who were admitted to the Blue Cross Brain Hospital for treatment from January 2017 to November 2018 were selected as research subjects.The diagnostic criteria of all the recruited patients were in accordance with the expert consensus on patients with severe infection of China Neurological Surgery.The patients were randomized into 3 groups:the HBO + diluted antibiotic alveolar wash group (or group Ⅰ) (63 cases),the diluted antibiotic alveolar wash group (or group Ⅱ) (63 cases) and venous antibiotic infusion group (or group Ⅲ) (61 cases).After 30 days of treatment with the above-mentioned treatment profiles,arterial blood gas partial pressure,changes in GCS scores,mechanical ventilation time,length of ICU stay and clinical effects both before and after treatment were closely observed and compared between the 3 groups.Results After 3 courses of treatment,the levels of arterial blood gas partial pressure and GCS scores were all obviously increased as compared with those before treatment,and statistical significance could be seen when comparisons were made between them (P ＜ 0.01).The arterial blood gas partial pressure of group Ⅰ was significantly higher than that of the 2 other groups,also with statistical significance (P ＜ 0.05).The mechanical ventilation time and length of ICU stay of the patients of group Ⅰ were considerably shorter than those of group Ⅱ and group Ⅲ,also with statistical significance (P ＜ 0.05 or P ＜ 0.01).Total efficacy rate of group Ⅰ (92.1％) was obviously higher than that those of group Ⅱ (84.1％)and group Ⅲ (77.1),also with statistical significance (P ＜ 0.05).Conclusion HBO combined with sensitive antibiotic alveolar wash in treatment of severe craniocerebral injury complicated with pulmonary infection could achieve significant effects.For this reason,it is worth further clinical extension.