Clinical Study Of Bronchoscopic Sputum Aspiration Combined With Alveolar Lavage In The Treatment Of Ventilator Associated Pneumonia Caused By Acinetobacter Bauman

bjective:To explore the therapeutic value and safety of bronchoscopic sputum aspiration combined with saline alveolar lavage in the patients with ventilator associated pneumonia（VAP）induced by Acinetobacter Bauman.Methods:This study was randomly selected from General Hospital of Chengdu Military Region and intensive care unit of Shuangliu District First People’s Hospital from June 2016 to May 2017,84 patients were treated.According to the respiratory diseases branch of the Chinese Medical Association‘A guide to diagnosis and treatment of nosocomial pneumonia（Draft）’:48 hours after mechanical ventilation and 48 hours after endotracheal intubation,Monitoring of body temperature,blood leucocyte,airway secretions,oxygen saturation,chest radiography,pulmonary exudation,etc.The pulmonary infection score（CPIS）was calculated at 6 points or above.It was diagnosed and diagnosed as ventilator associated pneumonia caused by Acinetobacter Bauman by sampling and culture under the fiberoptic bronchoscope anti pollution brush.With the use of SAS statistical software PROCPLAN process statements,given the number of seeds,the patients who conform to the exclusion criteria are randomly assigned to the test group and the control group.The experimental group（the group with routine treatment and bronchoscopy sputum suction combined with saline lavage treatment）and control group[only routine treatment means,including nursing（30 degrees to 45 degrees head elevation）,timing turn,assistance,adequate analgesia treatment,preventive measures（prevention of stress ulcer）,appropriate endotracheal tube cuff pressure（20³0cmH2O）,antibiotic therapy,oral care,airway nursing,blood glucose control（10mmol/l=8 random blood glucose target）,air disinfection unit etc.].The mechanical ventilation time,ICU of the two groups of patients in hospitalization days and total hospitalization expenses,7 days of treatment efficiency,the 28 day survival rate,before treatment and 7 days after infection index（white blood cell count,neutrophil percentage,procalcitonin）changes before and after 7 days of treatment of acute physiology and chronic Health（APACHE II）score and CPIS score were analyzed to assess the effectiveness,and the experimental group were treated with fiberbronchoscope sputum and bronchoalveolar lavage saline 20 min before treatment and after treatment 20minutes of heart rate（HR）,cardiac index（CI）,stroke volume（SV）,mean arterial pressure（MAP）,oxygen saturation（Sp O₂）were recorded to assess the safety of the treatment.Results:Compared with the control group,there was a significant difference in the duration of mechanical ventilation,the length of hospital stay and the total hospitalization expenses of the experimental group（P<0.05）,indicating that the experimental group had shorter mechanical ventilation time,ICU hospitalization days and lower hospitalization expenses than the control group.The CPIS score,acute physiology and chronic health score（APACHE II）,total white blood cell count（WBC）,neutrophil percentage（N%）and procalcitonin（PCT）level in the experimental group were significantly different from those in the control group（P<0.05）.The results showed that the index of infection in the experimental group decreased more significantly,and the improvement of the disease was more obvious.There was a significant difference in the level of SpO₂ between the experimental group and the bronchoalveolar lavage treatment group（P<0.05）.After treatment,the SpO₂ level was better than that before treatment,suggesting that this treatment can improve the hypoxic state of the patients.There was no significant difference in heart rate,mean arterial pressure,heart index and stroke volume before and after treatment with sputum suction and alveolar lavage in the experimental group（P>0.05）.It is suggested that bronchoscopy sputum suction combined with normal saline bronchoalveolar lavage therapy has no significant effect on hemodynamics in patients with VAP caused by Acinetobacter Bauman,and has high safety.There was a difference between the two groups of patients after 7 days of treatment（P<0.05）,and the effective rate of the patients in the experimental group was significantly better than that of the control group.However,there was no significant difference in the 28 day survival rate between the two groups（P>0.05）.Conclusion:Bronchoscope sputum aspiration combined with saline lavage treatment compared with only accepted conventional treatment means of Bauman Acinetobacter caused by VAP patients,can significantly improve the infection related indicators,shorten the mechanical ventilation time,ICU length of hospitalization,reduce the total hospitalization expenses of patients at the same time,the operation itself has a good safety for such patients.However,there was no significant difference in the 28 day survival rate between the two groups.Whether there was a small number of studies or the frequency of sputum aspiration combined with normal saline in the treatment of bronchoalveolar lavage is still needed for further research.