内科

目的探讨纤维支气管镜（简称纤支镜）吸痰联合靶向体位引流对脑卒中气管切开术后肺部感染患者的干预效果。方法选取62例脑卒中气管切开术后肺部感染患者作为研究对象，采用随机数字表法将其分为对照组和观察组，每组31例。两组均接受常规治疗与护理、机械振动排痰及呼吸康复训练（主动循环呼吸技术、手法辅助咳嗽、吸气肌训练），观察组在此基础上增加纤支镜吸痰联合靶向体位引流，干预周期均为14 d。比较两组干预前后的24 h排痰量、血气分析指标［动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（OI）］、炎症指标［白细胞（WBC）计数、C反应蛋白（CRP）水平］及肺部湿啰音消失时间、肺部感染控制情况，记录两组干预期间不良事件发生情况。结果最终60例患者完成干预，每组30例。干预前，两组24 h排痰量、PaO2、PaCO2、OI、WBC计数、CRP水平差异均无统计学意义（均P>0.05）。干预14 d后，两组24 h排痰量均较干预前增多，PaO2、OI均较干预前升高，PaCO2、WBC计数、CRP水平均较干预前降低（均P<0.05）；观察组24 h排痰量多于对照组，PaO2、OI均高于对照组，PaCO2、CRP水平均低于对照组（均P<0.05）；观察组肺部湿啰音消失时间短于对照组，肺部感染控制率高于对照组（均P<0.05）。干预期间，两组均未发生纤支镜操作相关及体位引流相关不良事件。结论纤支镜吸痰联合靶向体位引流可有效增加脑卒中气管切开术后肺部感染患者的24 h排痰量，改善氧合功能，降低炎症指标，提高肺部感染控制率，且安全性良好。

Objective To explore the interventional effect of fiberoptic bronchoscope-guided sputum suctioning combined with targeted postural drainage in patients developing pulmonary infection after tracheotomy for stroke. Methods A total of 62 stroke patients developing pulmonary infection after tracheotomy for stroke were enrolled and divided into a control group or an observation group by the random number table method, with 31 cases in each group. Both groups received routine treatment and nursing, mechanical vibration-assisted sputum expectoration, and respiratory rehabilitation training (including active cycle of breathing technique, manual assisted coughing, and inspiratory muscle training); on this basis, the observation group was additionally treated with fiberoptic bronchoscope-guided sputum suctioning combined with targeted postural drainage; both groups received an intervention of 14 days. The 24-hour sputum expectoration volume, blood gas analysis indicators (arterial partial pressure of oxygen [PaO2], partial pressure of arterial carbon dioxide [PaCO2], and oxygenation index [OI]), inflammatory indicators (white blood cell [WBC] count and C-reactive protein [CRP] level) before and after intervention, the time to disappearance of pulmonary moist rales, and the control rate of pulmonary infection were compared between the two groups, and adverse event incidence during the intervention were recorded. Results A total of 60 patients completed the intervention, with 30 cases in each group. Before intervention, there was no statistically significant difference in 24-hour sputum expectoration volume, PaO2, PaCO2, OI, WBC count, or CRP level between the two groups (all P>0.05). After 14 days of intervention, the 24-hour sputum expectoration volume increased, PaO2 and OI elevated, while PaCO2, WBC count, and CRP level decreased in both groups as compared with those before intervention (all P<0.05). Compared with the control group, the observation group had higher 24-hour sputum expectoration volume, PaO2, and OI; lower PaCO2 and CRP level; shorter time to disappearance of pulmonary moist rales; and higher control rate of pulmonary infection (all P<0.05). No adverse event related to fiberoptic bronchoscope operation or postural drainage occurred in either group during the intervention. Conclusion Fiberoptic bronchoscope-guided sputum suctioning combined with targeted postural drainage can effectively increase the 24-hour sputum expectoration volume, improve oxygenation function, reduce inflammatory indicators, and elevate the control rate of pulmonary infection in patients developing pulmonary infection after tracheotomy for stroke, with good safety.

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