Clinical Study On The Treatment Of Refractory Pneumonia With Fiberoptic Bronchoscopy Lavage Combined With Systemic Antibiotics Therapy

Objective:The methods of systemic antibiotics therapy or combined fiberoptic bronchoscopy lavage are usually used for patients with refractory pneumonia. The paper is focus on comparing the treatment efficacy of the two methods, evaluating the superiority of fiberoptic bronchoscopy lavage combined with systemic antibiotics therapy, to facilitate its clinical application.Methods:The 183 patients with refractory pneumonia were randomly selected from those who, from Nov.2006 to Nov.2009, admitted to the Department of Respiratory Medicine, Hospital Affiliated Chifeng College, Inner Mongolia. All patients were those whose clinical manifestation was not improved with 10 days of systemic antibiotic therapy. Being informed of the related matters of combined fiberoptic bronchoscopy lavage treatment, those who agreed to the treatment and signed informed consent were regarded as the experimental group; those who refused to accept the fiberoptic bronchoscopy lavage and hope for continuous systemic antibiotic therapy were regarded as the control group. All the data about age, sex, clinical manifestation are comparable for the two groups and the treatments were in line with ethical standards. The patients in control group were continually administrated with systemic antibiotic and adjunctive supporting treatment, while the patients in experimental group were treated by systemic antibiotic together with the fiberoptic bronchoscopy lavage for 2 to 3 times per week. Two weeks later, the parameters of the two groups were compared, such as clinical efficacy, white blood cell count and neutrophil percentage, bacterial culture negative rates and so on. The data were statistically analyzed.Results:Two weeks after the treatment, the total treatment effective rate of the experimental group were statistically higher than that of the control group (P<0.05). Before treatment, among the 95 patients of the experimental group, sputum bacterial culture were positive in 55 patients, 55 bacterial strains were found,and the positive rate was 57.89%, while after fiberoptic bronchoscopy lavage, bacterial culture were positive in 85 patients with 5 mixed infection,90 bacteria strains were found, and the positive rate was 89.4%. Among the 88 patients of the control group, sputum bacterial culture were positive in 52 patients with 5 mixed infection, and 57 bacterial strains were found. After two weeks'treatment, the effective rate of the experimental group was significantly higher than that of the control group (P<0.01), on the basis of the results that the bacterial culture positive in 27 patients, and the negative conversion ratio 68.24% in the experimental group, while the bacterial culture positive in 57 patients with new 14 patients, and the negative conversion ratio 17.31% in the control group. Furthermore, the white blood cell count and neutrophil percentage of the experimental group were significantly decreased compared with the control (P<0.01),the inflammation on the image was obviously absorbed in the experimental group compared with the control (P<0.01), and the average hospital stay of the experimental patients was statistically shorter than that of the control group (P<0.01). Furthermore, after 15 minutes treatment of fiberoptic bronchoscopy lavage the patients' heart rate and blood pressure had no statistically differences than before (p>0.05), and yet the oxygen saturation was significantly higher (p<0.01).Conclusion:With the advantage of simple and safe, high and accurate pathogens detection rate, as well as patients'well-tolerance, low incidence of adverse reactions, and short average hospital stay, the method of fiberoptic bronchoscopy combined with systemic antibiotics therapy is more available for treating the refractory pneumonia, so it is attractive to promote the protocols'clinical application.